Homelessness

Homelessness

Homelessness is a condition of detachment from society characterized by the absence or attenuation of the affiliative bonds that link settled persons to a network of interconnected social structures.

Homelessness takes many forms, depending on the type of detachment involved and the local circumstances. Homeless families and homeless men appear, so far as can be determined, in all largescale societies. Homeless women and children are relatively rare. Their appearance denotes wide spread disorder and instability, such as follow famines and civil wars.

Degrees of homelessness. Homeless families fall into three general types: permanent wanderers, such as gypsies and carnival performers; wanderers with a fixed base, especially migratory farm workers; and refugees, for whom homelessness is an accident and not a way of life. Homeless men fall into a variety of categories.- single men in itinerant occupations, such as peddlers, tinkers, and sailors; migratory laborers; vagrants and beggars; religious mendicants; outlaws and other fugitives; and hoboes and derelicts.

These types suggest that homelessness is a matter of degree, ranging from temporary to perma nent and from the loss of a single affiliation to the absence of all affiliations. In general, homelessness is less acute for families than for individuals. The homeless family may have no place in any community, but its members carry a web of roles and obligations with them wherever they go. Some, like the gypsies, develop something like a portable community independent of the surrounding social structure. Others, like the millions of families displaced toward the end of World War II, are ren dered homeless without their consent and resume normal affiliations at the first opportunity.

There is even more variation in degree of home-lessness among men without families. Some, like the itinerant worker, may preserve multiple affiliations: occupational, religious, political, and so on. They are only as homeless as their mobility forces them to be. Others, like religious mendicants, elect one overriding identification that supplants all of their former roles.

At the extreme point of the scale, the modern skid row man demonstrates the possibility of nearly total detachment from society. The present discussion is focused on this end of the homelessness scale and omits any consideration of the minor degrees of homelessness represented by Bohemians, “beatniks,” troubadours, residents in alien societies, and other adventurers whose partial detachment from role obligations is arranged deliberately and with substitute goals in view.

Homelessness as a syndrome. The common characteristics of homeless populations display a distinct and unmistakable pattern that is roughly applicable to any homeless population though fully descriptive of none. Homeless persons are poor, anomic, inert, and nonresponsible. They command no resources, enjoy no esteem, and assume no burden of reciprocal obligations. Social action, in the usual sense, is almost impossible for them. Lacking organizational statuses and roles, their sphere of activity extends no further than the provision of personal necessities on a meager scale. Their decisions have no implications for others. Only the simplest forms of concerted action are open to them, since homelessness is incompatible with sustained involvement in a complex division of labor.

The observable behavior of the homeless person consists largely of activities that furnish subsistence or enjoyment without incurring responsibilities: mendicancy, petty crime, scavenging, casual conversation, and an incurious attention at spectacles. This quality of social inertness renders him both innocuous and helpless. He is unlikely to engage in major crime or political movements or to protest his own condition forcefully. A certain apathy regarding self-preservation often develops in addition to the collective helplessness. The home less in great cities and in refugee camps stand and watch their companions assaulted by strangers without offering to interfere and without taking any measures to protect themselves. The combined effect of poor nutrition, exposure of all kinds, neglect of injuries and illness, and insensitivity to emergencies leads to very high rates of morbidity and mortality among homeless persons as compared to the settled population around them.

The homeless versus the settled. For reasons not entirely understood, the presence of homeless persons often arouses a degree of hostility in the settled population that seems entirely disproportionate. Ancient ballads preserve the image of the gypsy as rapist and kidnapper. Being homeless or vagrant became a felony in England in the fourteenth century and a capital crime under the Tudors; it is still treated as a criminal offense in most American and European cities. These external attitudes and the punitive measures to which they lead further separate the homeless man from his settled neighbor. Homeless populations often occupy an underworld with a special argot, secret signs, and a conventional refusal to communicate with outsiders. Such manifestations may lead romantic observers to imagine an entire clandestine social system, such as the “kingdom of beggars” or the “hobo republic,” but on closer view, these fantasies disappear and reveal the homeless as an aggregate of unrelated individuals who share a common situation and some elements of a common culture.

A theory of homelessness. The Germanic term “home,” with its special connotations of warmth, safety, and emotional dependence, has no exact equivalent in other linguistic systems. Aside from its familiar overtones, it expresses the idea of a fixed place of residence shared with a limited number of other persons. In current usage, home does not imply a family (unrelated persons can “make a home” together), a household (a rest home may be much larger), more than moderate fixity (in any given year, more than one in five U.S. families moves to a new home), or exclusivity (a special body of tax law covers taxpayers with two or more homes). Living outside a family, with no permanent address, does not make a priest or a soldier homeless, but the man who occupies the same lodging on skid row for forty uninterrupted years is properly considered homeless. The essence of the concept goes beyond residential arrangements. Homelessness is best visualized as a relationship to society at large and best understood by examining the difference between the settled and the homeless.

A settled, active adult in any society participates simultaneously in several major types of organization. This participation anchors him in the social structure by linkages with near and distant kin, neighbors, compatriots, superiors and subordinates, co-workers, departed ancestors, sacred and supernatural personages, persons with the same special interests, and even those who like to play the same games. Each of these memberships involves duties and privileges, restraints and rights, status and roles. Each requires sustained interaction with particular other persons who enter into the subject’s life history and become part of the audience for his socially meaningful acts.

The pattern of these affiliations varies in detail from one time and place to another, but the main outlines remain unchanged. In modernized countries of the twentieth century, the individual’s at tachment to society seems to be mediated through eight major types of organization: family, school, community, state, production group, occupational union, church, and recreational associations. Taken together, these memberships define who the settled person is, how he schedules his days and his years, and the benefits he may claim from, and the duties he owes to, the social order. Above all, they identify the others who are influenced by him and define the extent of that influence.

The fully homeless man is unaffiliated in all sectors. He is not an active member of any organization and therefore has no enforceable responsibilities toward fellow members, no audience of persons influenced by his actions, no claim on social rewards beyond whatever minimum has been set to avoid the scandal of his starvation, and no duties to fulfill except those imposed as a condition of remaining in the territory. Clearly, this condition will be uncomfortable and sometimes dangerous. On the other hand, it may be attractive to those who reject the cultural goals together with the means of achieving them.

Homelessness as an ideal. The age of modernization is singularly unsympathetic to the positive values of homelessness. However, in other times and places it has been regarded as a desirable, or at least admirable, way of life.

The exaltation of homelessness as an ideal is a central, recurrent theme of Christianity, reflecting such scriptural teachings as “lay not up for your self treasures on earth.” Poverty, detachment from previous affiliations, and the abandonment of worldly aspirations are the first principles of monasticism. The Christian ethos of vagrancy was most fully developed by St. Francis of Assisi and the several orders of wandering, mendicant friars who followed the Franciscan model.

A parallel theme runs through Muslim history. The “St. Francis of Islam” is Mulai ’Abd al-Qadir al-JIlani (1078–1166), the patron of the needy and suffering. From the Muslim viewpoint, the beggar performs a kind of social service by enabling others to attain merit by almsgiving: “As long as Islam flourishes,” says one writer, “there will be beggars, for there will always be devout people who will give away all they have, and so become beggars themselves” (Edwards 1912, p. 931).

In addition to friars, hermits, and holy beggars, Christianity and Islam recognize and honor the pilgrim, who becomes a homeless wanderer temporarily, partly for the spiritual benefit of visiting the sacred shrine and partly to withdraw from settled society. In the Middle Ages pilgrims played a vital part in integrating both the Christian and Muslim worlds. The pilgrim routes to Mecca and Medina, to Rome and Santiago de Compostela, are as crowded today as ever, but the modern pilgrim is more often a religious tourist than a holy vagrant.

The ethos of vagrancy is even more conspicuous in Buddhism. Buddha and his disciples were members of an already ancient order of wandering almsmen, and Buddha charged his disciples to “go forth and wander about for the good of the Many.” The bhikshu-sangha was (and is) a community of homeless men entered by “going forth from a house to a houseless state.” A bhikshu is an almsman. “He is differentiated from an ordinary beggar by the sacramental character of his begging. His beggary is not just a means of subsistence, but an out ward token that he has renounced the world and all its goods and thrown himself for bare living on the chances of public charity” (Dutt 1962, p. 36).

Similar themes exalting homelessness and attaching a positive value to mendicancy may be discerned in Hinduism, the religion of Zoroaster, and a number of Hellenistic cults. Indeed, approval and abhorrence of religious mendicancy may occur together. One appeal of the world religions may lie precisely in their ability to combine doctrinal elements supporting the performance of status obligations with others that allow the believer to with draw from the world without penalty.

Although the traditional types of homelessness may still be observed on the contemporary scene, they are overshadowed by new forms that arise directly from the dominant processes of the modern era: industrialization, urbanization, decolonization, and the redistribution of political power. The three types to be considered here are refugees, migratory workers, and skid row men.

Refugees. Involuntary migration has occurred throughout historic times, but the displacements of the twentieth century have been unprecedented in scale, scope, and duration. Refugees are persons who migrate to escape actual or threatened persecution because of their race, religion, political convictions, or for any reasons related to war (Proud-foot 1957, pp. 53, 446). A broader definition of refugees includes any persons compelled to abandon their homes because of events for which they cannot be held responsible (Vernant 1953, p. 3).

The involuntary migration of refugees contrasts sharply with voluntary migration in search of economic opportunities. Voluntary migrants are mostly young adults usually assured of a welcome in the host country and of continued ties with the country of origin. Involuntary migration often affects entire communities, including people of all ages and conditions, uprooted without their consent and set down in a place selected at random, where their numbers increase their helplessness.

The wars and revolutions of the twentieth century have created both temporary and permanent refugees. The temporary refugee may flee from his home in the face of an invading army to return at the first opportunity. The permanent refugee leaves a country where his enemies have come to power with no real hope of eventual return. Sometimes he is resettled after an interval of hardship in a new community among people of his own persuasion. But if no such place is available, he may linger indefinitely in refugee camps, living on a dole. One observer speaks of Heimatlosenauslander as “ultimate refugees” and describes their loss of affiliations:

Here you meet men whose environment has ceased to succour them. In their former normal life they had the solace of their homes in times of weariness or perplexity, perhaps even in times of unemployment. They had the consolation of their church in times of spiritual need and of family sadness. They had their trade union and political association in times when work and politics preoccupied them. They had their village inn and folk festivals on high days and holidays. All these props and cushions in life’s pilgrimage are taken from them…. (Rees 1960, p. 37)

The large-scale refugee movements of the twentieth century began with the Balkan wars of 1912–1914. World War I displaced several million civilians, most of whom were subsequently relocated. Almost every major disturbance of the interwar period generated a refugee problem, and World War ii displaced between 20 and 50 million persons; the exact number is unknown and cannot be accurately estimated. In the postwar period, the displacement of populations continued unabated in Europe, Asia, Africa, the Near East, the islands of the Pacific, the Mediterranean, and the Caribbean. Not without reason has this been called the “cen tury of the homeless man.” Most refugees are ultimately resettled, but not without great cost in suffering and dislocation. Meanwhile, the making of refugees continues at a rate that reflects the peculiar and fanatical character of twentieth-century nationalism.

Migratory farm laborers. Large-scale agriculture often requires large amounts of hand labor for brief seasonal periods. This situation frequently occurs during the transition from a plantation or family farm system with a fixed labor force to a fully mechanized system of cultivation. The transition may extend over several decades, during which the local labor force is incapable of planting and harvesting a crop without outside help. Arranging the appearance of the required number of workers at the right time and place is a perennial problem for the planters. Protecting the workers against exploitation and the natural hazards of migration is a major problem for whatever authorities assume the responsibility.

Seasonal migratory labor is required for such diverse products as coffee, cocoa, rubber, cotton, citrus fruits, wheat, apples, potatoes, and wild rice. The seasonal movement of migratory workers is significant throughout the world, often transmitting a modernizing influence from advanced to backward areas. The preliterate tribesmen brought to the coastal banana plantations of Central America, the Italian peasants cultivating sugar beets in France, the tribal Africans who migrate to cocoa plantations of Ghana, and the Mexican braceros picking peaches in Oregon all acquire new ideas and attitudes to carry back with them.

Movements of this kind are often internal as well as international. In the United States in the middle 1960s, for example, Mexicans were admitted annually on a temporary basis under a farm labor program jointly administered by the two countries, and sizable numbers were drawn under other programs from Canada, the British West Indies, Japan, and Puerto Rico. But the stream of migrants is also fed by many internal groups: Indians, mountain whites, Spanish Americans, and southern Negroes. The annual cycle begins in the South and moves steadily northward with the advancing season; some workers follow the wheat harvest all the way from southern Texas to Manitoba.

Migratory laborers vary in degree of homeless-ness. John Steinbeck’s novel, The Grapes of Wrath, painted an unforgettable picture of migrant families displaced from their ancestral farms in Oklahoma during the depression and cut loose to drift helplessly from one temporary job to another. Even in times of prosperity, the United States has an estimated one million transients who have no fixed base (Shotwell 1961, p. 34); and there are many others who have home bases to which they return between seasons or when forced back by unemployment.

A migrant work force may be composed of single men, entire families, or both. Their living and working conditions range from adequate to wretched. Like other homeless persons, migratory workers are prevented from forming or retaining normal affiliations and are subject to disproportionate hostility from their settled neighbors.

Migrancy engenders community resentment, puts in peril such practical aspects of normal family living as regular schooling for children, housing that is sanitary and convenient and conducive to wholesome family relationships, voting privileges, stable income, health and welfare services available to residents. Migrancy reduces to zero the chance to develop the feeling of belonging to a stable community. (Shotwell 1961, pp. 36-37)

The farm laborer occupies a place at the very bottom of the socioeconomic ladder, doing the most work for the lowest wages with less security and opportunity than any other segment of the population.

Solidary organizations among migrant laborers are rare. Attempts to unionize them, when not vio lently suppressed, have usually failed. However, a loose form of crew organization often develops, whereby a group of individuals or families is represented by a leader who negotiates with employers and arranges transportation and lodging.

The impact of this form of homelessness on in dividuals is mitigated by its temporary character. The available evidence suggests that most migra tory workers return to a settled life at the first opportunity, often in an area they have discovered as migrants.

The skid row man. In proportion to their numbers, skid row men in the United States and comparable homeless men in western Europe have received disproportionate attention from both scientific and literary observers. In a study using 1950 census data, Bogue (1963) identified skid row areas in 41 American cities and estimated their combined homeless population at under 100,000. The individual settlements are correspondingly small. Careful enumerations in the New York Bowery, one of the most conspicuous skid row areas in the world, disclosed less than seven thousand homeless men in 1964 and 1965 (Baker 1965, p. 7).

The name “skid row” (or “skid road”) appar ently derives from the log skidways on which felled timber was transported in the forests of the Pacific northwest. It came to be applied to the Seattle area where lumbermen wintered and then to similar enclaves in other cities where single homeless men were housed in dormitories and lodging houses, surrounded by facilities that served their special needs. Most of these enclaves, in their present locations, can be traced back about a century. In recent decades, their populations have been declining, although irregularly; and the migratory workers identified as the principal inhabitants of “hobo-hemia” after World War i (Anderson 1923) have given way to the practically immobile pensioners, alcoholics, and disadvantaged workers who make up the bulk of the population today.

The interest aroused by skid row may be explained partly by its unique institutions, partly by its high visibility, partly by the resistance of the skid row alcoholic to ameliorative programs, and partly by a life style that deviates dramatically from the success-oriented, family-centered ethos of the surrounding society. The visible facilities are cubicle lodging houses, cheap restaurants and bars, missions, barber colleges, secondhand stores and pawnshops, newspaper reading rooms, sidewalk gatherings, all-night movies and burlesque shows, tattoo parlors, “jungles” near railroad yards, and the “revolving door” of police court and workhouse. In several major cities the original area has been cleared in the course of urban redevelopment, but substitute skid rows have invariably appeared.

Ethnic and occupational characteristics vary somewhat from one skid row to another, but the population is almost exclusively male. Their average age is much higher than that of the general popu ation; a large proportion are past the usual age of retirement (Bogue 1963, pp. 8-10). About a third of the men are heavy drinkers, frequently arrested for drunkenness and apparently addicted to alcohol, although there is some doubt about their being true alcoholics. The remainder are divided between social drinkers, whose need for liquor is apparently controllable, and moderate drinkers or abstainers (Bogue 1963, pp. 90-93). Most report themselves unmarried and without active family ties. Their histories show less than average involvement in family relationships from early childhood on (Pitt-man & Gordon 1958, pp. 10, 125-138). Their organizational affiliations have often been slight throughout adult life, reflecting a permanent state of social detachment. The typical skid row man has a background of intermittent unskilled or semiskilled employment, with minimal involvement in political, religious, and recreational organizations (Bahr & Langfur 1966).

Morbidity and mortality rates are startlingly high. The risks of contagious disease, infection, exposure, injury, and malnutrition are greater on skid row than in any other urban environment (Bogue 1963, pp. 199-230). Most men live close to the margin of bare subsistence on sporadic earnings, pensions, relief payments, begging, or some combination of these. A few depend on savings or assistance from relatives; a few enjoy regular incomes and remain on skid row by preference (Bogue 1963, pp. 13-17; 46-77).

In addition to the core population, the skid row area provides temporary accommodation for migratory workers and work seekers, eccentrics, and fugitives of various kinds. Some of these men are not strictly homeless, and some homeless men have no contact with skid row. However, the predominant type is unmistakable.

The principal current trends in the status of skid row inhabitants are decreased mobility and a decline of relative income. There is, however, a rising provision of public assistance for them, and experimental programs are being undertaken in the rehabilitation of alcoholics.

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Homelessness

Homelessness

Definition

In the United States, definitions of homelessness help determine who is able to receive shelter and assistance from certain health and social service providers. The Stewart McKinney Homeless Assistance Act of 1987 defines a homeless person as any individual who lacks housing, including an individual whose primary residence during the night is a supervised public or private facility that provides temporary living accommodations or an individual who is a resident in transitional housing. More specifically, this means an individual who lacks fixed, regular, and adequate nighttime residence, and an individual who has a primary nighttime residence that is either (i) a supervised temporary living shelter (including transitional housing for the mentally ill), (ii) an institution that provides temporary residence for individuals intended to be institutionalized, or (iii) a place not designed for or ordinarily used as a regular sleeping accommodation for human beings.

Difficulties in estimating numbers of people who experience homelessness

Methods for estimating the size of the homeless population are evolving and sometimes contested, and are complicated by varying definitions of homelessness. The
U.S. Census, while attempting to identify the number of people who are homeless and who use particular types of homeless services, has complex and service-based definitions of homelessness. It also has recognized its limited abilities to define and enumerate the homeless (it is after all a national household survey). In 2000, the Census Bureau defined the Emergency and Transitional Shelter (E&TS) population by surveying people who use a sample of homeless services. They counted homeless people in emergency shelters for adults, runaway youth shelters, shelters for abused women and their children, soup kitchens, and certain outdoor locations. Technically, however, homeless people may reside in "E&TS," in foster care, in jails and prisons, in group homes , in worker dorms, non-sheltered in the outdoors, doubled up with families or friends, or temporarily in Census-recognized households. According to the National Coalition for the Homeless, while counting the number of people who use services such as shelters and soup kitchens can yield important information about services, applying these numbers toward estimating numbers of homeless people can result in underestimates of homelessness.

Further complicating the issue of counting homeless people is the fact that, in many cases, homelessness is a temporary condition. Because of this fact, some researchers advocate a method of counting all the people who are homeless in a given week or, alternatively, over a given period of time. However, the numbers of people who find housing and the number of people who newly find themselves homeless fluctuates over time periods. In contrast, people with mental illness or substance abuse problems tend to be chronically without homes—it is difficult
for many of these people to find permanent housing. Thus, while these two time-oriented methods of counting homeless can be useful, they too have statistical problems—they can overestimate the numbers of homeless people.

Homelessness is an acute version of residential instability, which can be compared or contrasted with definitions of poverty. Thus the term homeless may also be extended to include people who have nowhere to go and are at imminent risk of losing housing through eviction or institutional discharge. Some definitions of homelessness further specify the duration of time without regular and adequate residence, or the types of temporary living shelter or institutions that are not fixed residences. People who live without alternatives in overcrowded or unhealthy housing conditions may be at risk of homelessness. Worldwide, national and cultural groups may have variable and often different definitions of homelessness, different terms for the condition of being without housing, and different definitions of adequate housing. For all of these reasons related both to methods of counting and varying definitions, estimating the size of the homeless population is extremely difficult.

Demographics

Census estimates of the size and composition of the homeless population are difficult to create, for reasons described above. The Emergency and Transitional Shelter (ET&S) Population count in the U.S. in 1990 was 178,638. It remained relatively stable in 2000 at 170,706. However, this figure does not include homeless adults not using ET&S services, sampling error, or some groups of homeless people not enumerated in the ET&S count. The ET&S population in 2000 was 61% male and 74% adult. Among the 26% who were youth, 51% were male. For adults, the population was 65% male, 41% were white, 40% were African-American, 20% were Latino of any race, 2% were Asian, 2% were Native American, and 9% were one other race alone.

Another estimate of homelessness is a 1988 count of homeless people that occurred over one week, counting homeless people congregated on the street, in soup kitchens, and in shelters. That estimate was 500,000 to 600,000 people.

The large variation between these estimates illustrates that, as the National Coalition for the Homeless states, "By its very nature, homelessness is impossible to measure with 100% accuracy."

Incidence of homelessness and associated diseases and conditions

Homeless adults are poor and have high rates of unmet need for health care. This is in part because poverty is associated with higher risk and rates of illness, particularly mental illnesses including substance abuse. Homeless people experience disproportionate rates and symptoms of mental health disorders, including substance abuse disorders and dual diagnoses. For these reasons, large portions of federally funded homeless services are medical services, and homeless people are often viewed according to their present or past medical classifications.

Studies researching the incidence, distribution, and control of a disease in a population (known as epidemiological studies) find that between one-third and one-half of homeless people have mental health disorders and approximately two-thirds have either a mental health or substance use disorder. People with severe mental illness are likewise more likely to become homeless, particularly when the disorder is co-morbid (co-occurs) with substance abuse. For this reason, changes in rates of homelessness are often associated with changes in mental health care and hospitalization policies.

Mental illnesses compound the vulnerability and needs of homeless adults, as reported by the Surgeon General. Psychiatric disorders exacerbate many types of problems, including housing instability, morbidity (disease), and mortality (death). Psychiatric disorders and lack of stable living conditions complicate general health care for homeless adults.

History

The history of homelessness is intertwined with the history of poverty in the United States. Poverty has always been problematic for humanitarian reasons and because it conflicts with the ideal of prosperity for all. Social welfare, based on individualistic ideas of deserving and undeserving poor, has improved society but not eliminated persistent poverty or homelessness. The 1960s war on poverty was a widely shared value, but in the 1980s concern about homelessness was confounded by moral evaluations of individual behaviors. While
many in the U.S. have been poor or come from poor families, fewer have experienced homelessness. Therefore, the collective understanding of homelessness in the U.S. is limited in ways that the understanding of poverty is not.

Causes and consequences

Causes

People with mental illness are at higher risk for becoming homeless due to challenges associated with deinstitutionalization and transition planning, and both poverty and disability associated with mental illness.

Social research has studied the causes and consequences of homelessness, surveying homeless people, examining entrances into homelessness, exits from homelessness, and effects of homelessness on health and well-being. Promising explanations for increasing rates of homelessness in the 1980s have included mental disability and illness, lack of social support through jobs and marriage, increased use of drugs and alcohol, and the erosion of low-income housing in urban areas. These explanations mirror the processes of deinstitutionalization in mental health policy, unemployment, addiction and abuse, and urban decay. In other words, a direct correlation can be demonstrated between policies and trends and the rates of homelessness. As deinstitutionalization occurred, for example, the number of mentally ill people without homes increased.

Consequences

Consequences of homelessness include the exacerbation of problems which may have caused homelessness. Homeless people have less access to housing, jobs, health care, and basic needs like food and clothing. Isolation and lack of social support are well-documented aspects of homelessness, particularly for homeless people living with mental health or substance abuse disorders. Homeless women and men have been found to have significantly less family support than never-homeless women and men. Disaffiliation from family often limits opportunities for recovery and prevention.

Homeless service agencies

Services for homeless people can be divided into those providing medical care, those providing housing, and those providing other basic needs. Publicly funded agencies provide the majority of medical care, especially primary and mental health care. Public and private organizations share the responsibilities of providing shelter and housing services, through both large federal programs and smaller need and faith-based programs.
Private agencies deliver most other daily needs to homeless people, through food pantries, soup kitchens, and other charities. Limited data exists on vocational services for homeless adults.

Title VI of the McKinney Homeless Assistance Act of 1987 created the Health Care for the Homeless (HCH) program, authorizing federal funds for primary and mental health care to homeless people. Title VI authorizes several programs to provide a HCH program, a Community Mental Health Services block grant program, and two demonstration programs providing mental health and alcohol and drug abuse treatment services to homeless people. HCH funds support providers who offer mental health, case management , and health education services, as well as substance abuse treatment. In 1987, 109 grants were made for homeless health services with $46 million; 1996: $66 million were spent for this purpose. Now there are 122 McKinney grants in 48 states. In 1992, the Act was amended to include homeless and at-risk children, creating a medical home and source of health insurance for young people. The HCH program is the largest single effort to address the medical needs of the homeless. Each year, the HCH Program serves almost 500,000 clients in the U.S. To be a HCH service agency requires cultural and linguistic competencies, compassionate community outreach, and providers who reflect the community they serve.

The federal Center for Mental Health Services oversees Projects for Assistance in Transition from
Homelessness (PATH) grant program. PATH provides state funds in support services to individuals who are homeless or at risk of becoming homeless and have serious mental illnesses. These funds amounted to $22 million allocated to 365 providers in 1998. States contract with local agencies and nonprofit organizations to provide an array of services, including outreach, support services, a limited set of housing services, and mental health treatment.

There are several obstacles or barriers in providing health care to homeless people. First, homeless or persistently poor people may be concerned about their work and sustenance, devaluing their own medical needs. Alienation and depression among the homeless can also be an obstacle to providing care. There can be mutual communication problems between providers and patients. Providers may lack cultural understanding that eases work with homeless clients. Finally, lack of preventive maintenance of medical care by the homeless may result in expensive and extensive needs for care, including hospital care, which may stress the capacities of certain service providers.

Homelessness in context

Homelessness is both a form of poverty and an acute condition of residential instability. Homelessness is compounded by behavioral problems, mental health policy changes, disparities in health and health care, racial inequalities, fluctuations in affordable housing, and lack of social support. Overly individualistic views and explanations of homelessness do not reflect its multiple causes and effects. Like all groups, homeless people are diverse, experiencing and exiting homelessness for a myriad of reasons. Services for homeless adults likewise reflect a variety of needs and experiences. Nonetheless, homelessness remains a national and international concern, particularly in urban areas, for the twenty-first century.

How to help the homeless mentally ill

There are many ways that Americans can support community and federal efforts to help homeless people living with mental illness. Some strategies include:

• Support collective public and private efforts to build homes and provide health care for people with unmet medical needs.

• Become educated about the challenges faced by homeless and mentally ill people in American society.

• Stop the practice of equating people in poverty and with illness with their medical conditions, instead of recognizing them as human beings. Succeeding in this step could open doors for recovery of health and housing without demeaning the humanity of people in need.

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Homelessness

Nutrition and Well-Being A to Z
COPYRIGHT 2004 The Gale Group, Inc.

Homelessness

Homelessness is a global problem. According to a 1996 United Nations report, 500 million people worldwide were homeless or residing in low-quality housing and unsanitary conditions in 1995. The number of homeless continues to rise, however, and quantifying this population is difficult. Most homelessness rates are reported by service providers, and countries with the best-developed service systems will therefore report the highest number of homeless, a condition referred to as the service-systems paradox. Various other problems, such as double-counts, overcounts, the problem of mobility, and hidden homelessness also affect estimates.

In the United States, homelessness gained national attention in the early 1980s. While some people thought the growth in the homeless population was a result of the recession that occurred during this period, the problem has not gone away.

It is estimated that two million people per year are homeless in the United States. A report issued by the Urban Institute in 2000 stated that 2.3 million adults and children in the United States are likely to experience homelessness at least once in a year.

A way to get at the root of the problem is to understand the causes of homelessness. Worldwide, homelessness is caused by a breakdown in traditional family support systems, continued urbanization, the effects of structural adjustment programs, civil wars, and natural disasters. A shortage in affordable rental housing and an increase in poverty are thought to be two major factors contributing to the rise of homelessness in the United States. Other potential causes are the lack of affordable health care, domestic violence, mental illness, and addiction disorders. Often, individuals will have several risk factors causing them to "choose between food, shelter, and other
basic needs" (National Coalition for the Homeless, p. 6). Shelter is often the lowest priority, and is often unaffordable, and thus homelessness becomes a problem. Similar risk factors affect both the homeless and those who are experiencing poverty. Because homelessness and poverty are linked, efforts to improve poverty will inevitably decrease homelessness.

Economics of Poverty and Undernutrition

Looking at a nation's poverty data is one way to judge its economic wellbeing. In the United States in 2001, 32.9 million people were living below the poverty line, which was $9,034 for an individual (for a family of three, the poverty threshold in 2001 was a salary of $14,128, while for a family of four it was $18,104). However, the poverty rate dropped a half percentage point to 11.3 percent between 1999 and 2000.

Around the world, poverty is pervasive: one billion people lived in poverty in 2001. Poverty and hunger are undeniably linked, so that solving the hunger problem by feeding people, without attacking the poverty problem, does not address the root cause of poverty.

In 1999, 31 million households (10.1%) in the United States were on the verge of hunger, while 3 percent of households were hungry. Even more startling, between 750 and 800 million people around the world were hungry in 1996. Of these, 550 million were in Asia, while 170 million were in sub-Saharan Africa. Along with hunger comes undernutrition, which can pose serious health threats.

Consequences of Long-Term Undernutrition among Homeless Children

The Institute of Medicine has estimated the number of homeless children in the United States to be approximately 100,000 each night. Almost half of these children are younger than six years of age. Although this is a growing population, few studies have examined the effect of undernutrition on homeless children. However, recent studies have found that a poor diet
in early childhood has implications for long-term health and cognitive development.

Homeless children suffer several medical problems due to undernutrition, including chronic and recurring physical ailments, and higher rates of fever, cough, colds, diarrhea, and obesity . In addition, a greater incidence of infections, fatigue , headaches, and anemia , as well as impaired cognitive development and visual motor integration, has been documented in homeless children.

Government Programs to Reduce Hunger and Undernutrition

According to the United States Census Bureau, 5 million adults and 2.7 million children lived in hungry households in 1999. To combat hunger and the undernutrition problem, the United States government funds and administers several food programs, including the Food Stamp Program; the National School Lunch Program; the School Breakfast Program; the Special Supplemental Nutrition Program for Women, Infants and Children; the Child and Adult Care Food Program; the Emergency Food Assistance Program; and the Community Food and Nutrition Program.

The Food Stamp Program provides coupons for low-income families that enable them to buy food. The coupons are dispersed on a monthly basis, with the purpose of reducing hunger and malnutrition.

Through the National School Lunch Program (NSLP), schools can be reimbursed for providing nutritious meals to children. A nutritious school lunch provides children with one-third or more of their Recommended Dietary Allowance (RDA) for nutrients .

Similar to the NSLP, the School Breakfast Program offers reimbursements to schools for providing breakfast to students. This breakfast provides one-fourth or more of their RDA for nutrients. In addition, meals and snacks are provided for children at risk for hunger through the Summer Food Service Program for Children. The food is usually provided during educational and recreational activities, and one-third of the children's RDA is provided through this program.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) has a mission to improve the diets of women, infants, and children by providing monthly food packages that include certain foods.

Federal funds are provided to public and nonprofit child-care centers, family and group child-care homes, and after-school programs for meals and snacks to the populations they serve through the Child and Adult Care Food Program (CACFP). The programs are required to follow the nutrition standards set by USDA when providing meals.

Through the Emergency Food Assistance Program (TEFAP), food is distributed through emergency food shelters. The food is provided through
surplus commodities purchased by the United States Department of Agriculture (USDA). Low-income families are served as well.

Finally, the Community Food and Nutrition Program (CFNP) is the source of federal funding for programs providing hunger relief and improving nutrition for low-income individuals. The funding is provided on the local, state, and national levels.

Examples of organizations seeking to provide solutions to hunger and homelessness include the Food Research and Action Center, America's Second Harvest, the Center on Hunger and Poverty, Bread for the World, World Hunger Year, and the Food Industry Crusade Against Hunger. These organizations provide coordination and support to antihunger networks of food banks and food assistance programs, education of the public, and encouragement to policy makers for the expansion and protection of programs aiding the homeless.

Deficits in the Diet

Many homeless people rely on shelters and soup kitchens for their food intake. However, these sites may not provide an adequate diet. "Most shelters rely on private donations, a local food bank, and surplus commodity distributions. Because the nutritional quality and quantity of these resources vary greatly over time, meals may be nutritionally limited, even though the quantity of the food served may be acceptable to the recipient" (Wolgemuth et al., 1992, p. 834). Furthermore, easily stored and prepared foods do not provide the best nutritional value. These items are typically "high in salt, fat , preservatives, and empty calories (i.e., calories with little or no nutritional value), and low in variety, fiber , and protein " (Strasser et al., 1991, p. 70).

Due to the food sources of the homeless, deficits in the diet have been documented in numerous studies. The B vitamins , vitamin C, zinc , calcium , thiamine, folic acid, magnesium, and iron are all commonly found to be deficient in the homeless. Iron deficiencies are particularly common among the homeless, leading to high rates of anemia. In addition, the food that is likely to be offered at most local shelters and soup kitchens is high in salt, fat, and cholesterol , contributing to a high incidence of hypertension among the homeless.

Clearly, the homeless are a widely varied population, and responses to homelessness must also be varied in nature. Several such responses are needed. These include: prevention of homelessness through improving the housing stock; improving outreach through increased soup kitchens, emergency responses, and night shelters; and creating supportive housing to
help homeless persons reintegrate into society. Interagency coordination to improve services and the provision of enterprise development and skills training to improve the economic survival of the homeless are also needed. Finally, federal and local governments must be involved in efforts to help the homeless through policy development. This multifaceted approach will ensure a more effective response to homelessness.

Luder, E.; Ceysens–Okada, E.; Koren-Roth, A.; and Martinez-Weber, C. (1990). "Health and Nutrition Survey in a Group of Urban Homeless Adults." Journal of the American Dietetic Association 90(10):1387–1392.

Oliviera, N. L., and Goldberg, J. P. "The Nutrition Status of Women and Children Who Are Homeless." Nutrition Today 37(2):70–77.

Urban Institute (2000). "Millions Still Face Homelessness in a Booming Economy: New Estimates Reveal a Large and Changing Homeless Population Served by Growing Diverse Network." Available from <http://www.urban.org>

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Homelessness

Encyclopedia of Aging
COPYRIGHT 2002 The Gale Group Inc.

HOMELESSNESS

Prior to the current crisis (which began in 1980 when the number of homeless persons started to increase dramatically), definitions of homelessness included persons residing in substandard housing, such as single-room occupancy
(SRO) hotels, cheap boarding houses, and skid row flophouses. More recently, however, the term has been used solely to describe the plight of persons sleeping in shelters or public spaces; that is, the "visible" or "literal" homeless. Many persons are at-risk for homelessness on account of their being doubled-up with other persons in one apartment, having excessive rent burdens, or having very low incomes—an estimated one in ten New Yorkers fall into these risk categories.

The literature has used ages 40, 45, 50, 55, 60, and 65 as markers of aging among homeless persons. Increasingly, however, there has been a consensus that the definition of older homeless should include those age 50 and over, because many homeless persons who are in this age group look and act ten to twenty years older.

Two reviews of surveys of homeless people, and a nationwide survey of soup kitchens and shelters, identified substantial homelessness among the older adults, although they produced a wide range of estimates (between 2.5 percent and 27.2 percent) as the result of heterodox methods and definitions of old age. Between 1980 and 2000 the proportion of older persons among the homeless declined, though their absolute number grew. Moreover, the proportion of older homeless persons is expected to increase dramatically as baby boomers begin to turn fifty. Thus, with an anticipated growth of over 50 percent in the general population of those age fifty to sixty-four between 2000 and 2015, and a near doubling of those age fifty and over by 2030, it is likely that by 2030 the number of older homeless persons in the United States will grow from its 2000 level of between 60,000 and 400,000 to an estimated 120,000 to 800,000. (These large variations in numbers are due to different methods of enumeration.)

Risk factors for homelessness

Carl Cohen has proposed a model of homelessness in which various biographical and individual risk factors accumulate over a lifetime. Except in the case of extremely vulnerable individuals, homelessness is not likely to occur unless several of these factors coexist. In most instances, however, the ultimate determinants are the unavailability of low-cost housing and insufficient income to pay for housing. Finally, the length and patterns of homelessness reflect a person's ability to adapt to the street or shelter, along with
individual and system factors that may prolong homelessness. The principal risk factors that have been found to increase vulnerability to homelessness among older individuals are described below.

Race. While the proportionate representation of Caucasians is higher among older than younger homeless persons, African Americans are still over-represented among older homeless persons in the United States.

Age 50–64. Because of the entitlements available to persons at age sixty-five (e.g., Social Security), their proportion among the homeless is roughly one-fourth of their representation in the general population. Conversely, persons between fifty and fifty-nine years old are disproportionately represented among the homeless, compared with their representation in the general population (about one and one-half to two times).

Extremely low income (current and lifetime). Older homeless persons are likely to come from poor or impoverished backgrounds and to spend their lives in a similar economic condition. More than three-fifths work in unskilled or semiskilled occupations, with current income roughly one-half the poverty level.

Disruptive events in youth. Consistent with reports of high prevalence of childhood disruptive events among younger homeless persons, about one-fifth of older homeless persons have had disruptive events such as death of parents or placement in foster care.

Chemical abuse. Although prevalence rates of alcoholism vary, the levels are about three to four times higher among older men than among older women, and levels are higher among homeless men and women than among their age peers. Illicit drug abuse falls off sharply in homeless persons over fifty, but this may increase with the aging of the younger generation of heavy drug users.

Psychiatric disorders. The rates of psychiatric illness among older homeless persons have been biased by the difficulty that such persons encounter in attempts to be rehoused. Levels of mental illness have been found to be consistently higher among women than men, with psychosis more common among women and depression slightly more prevalent among men. Studies of homeless people in New York City have found that 9 percent of older men and 42 percent of older women displayed psychotic symptoms, whereas 37 percent of older men and 30 percent of older women exhibited clinical depression. Levels of cognitive impairment range from 10 to 25 percent, but severe impairment occurred in only 5 percent of older homeless persons, which is roughly comparable to the general population.

Physical health. Older homeless persons suffer a level of physical symptoms roughly one and one-half to two times the level of their age peers in the general population, although their functional impairment is not worse than their age peers.

Victimization. Both younger and older homeless persons report high rates of victimization. Studies have found that nearly half of older persons had been robbed and one-fourth to one-third had been assaulted in the previous year. More than one-fourth of women reported having been raped during their lifetime.

Social supports. Compared to their age peers, social networks of older homeless persons are smaller (about three-fourths the size), more concentrated on staff members from agencies or institutions, more likely to involve material exchanges (e.g., food, money, or health assistance) and reciprocity. Older homeless persons also have fewer intimate ties than their age peers. Although not utterly isolated, older homeless persons lack the diverse family ties that characterize older adults in the general population. Only 1 to 7 percent are currently married, versus 54 percent in the general population. Nevertheless, various studies have found that about one-third to three-fifths of older homeless persons believed that they could count on family members for support.

Prior history of homelessness. One of the key predictors of prolonged and subsequent homeless episodes is a prior history of homelessness. Lengths of homelessness are higher among older men than older women.

Once a person is homeless, evolution into long-term homelessness involves a process in which the individual learns to adapt and survive in the world of shelters or streets. Furthermore, certain persons (e.g., men, the mentally ill, those with prior homeless episodes) are more apt to remain
homeless for extended periods, most likely reflecting impediments at the personal and systems levels.

The two principal systemic factors that create homelessness are lack of income and lack of affordable housing. In cities where there may be adequate housing supplies, high levels of poor-quality jobs, unemployment, and low incomes make most housing unavailable to the poor. Conversely, in cities where incomes may be higher and jobs are more plentiful, tight rental markets stemming from middle-class pressure and escalating living costs also makes housing less available to lower-income persons. Both these conditions can push some people over the edge into homelessness.

Although it is now recognized that a majority of homeless persons do not suffer from severe mental illness, the closing of mental hospitals (deinstitutionalization ) has been often cited as playing a critical role in causing homelessness. There is strong evidence that deinstitutionalization does not exert a direct effect on homelessness, as there is usually a time lag between a person's discharge from a psychiatric hospital and subsequent homelessness, and many homeless people with mental illness have never been hospitalized for psychiatric illness. Thus, whereas mental illness may at times lead to homelessness, it is also apparent that the disproportionately large numbers of homeless mentally ill persons also reflect systemic factors such as the unavailability of appropriate housing and inadequate entitlements for this population.

At the service level, there has been a paucity of programs for homeless and marginally housed older persons. Age-segregated drop-in/social centers, coupled with outreach programs, have been shown to be useful with this population. Unfortunately, while many agencies proclaim an official goal of rehabilitating the homeless person and reintegrating them into conventional society, the bulk of their energies go into providing accommodative services that help the person survive from day to day.

Another potentially useful modality is a mobile unit, of the type developed by Project Help in New York City, to involuntarily hospitalize persons. Used judiciously, and being mindful of civil rights, such units can assist those elderly homeless who are suffering from moderate or severe organic mental disorders or from mental illness that is endangering their lives. Advocacy is also important. For example, in Boston, the Committee to End Elder Homelessness consists of a coalition of public and private agencies working to eliminate elder homelessness and to provide options for this population.

Based on the model of aging and homelessness described above, it is likely that the imminent burgeoning of the aging population will result in a substantial rise in at-risk persons. Prevention of homelessness among older persons will depend primarily on altering systemic and programmatic factors. In some geographic areas, where income supports and employment opportunities are greater, it will mean ensuring that there is adequate low-income housing stock. Conversely, in areas where cheaper housing may be available, it will be necessary to boost entitlements to levels sufficient to make existing housing affordable. Finally, for people who become homeless, there must be an expansion of programs targeted to the needs of older persons that work seriously towards reintegrating these persons into the community.

Carl Cohen

See also Baby Boomers; Housing; Living Arrangements; Mental Health Services.

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Homelessness

Homelessness

The National Law Center on Homelessness and Poverty indicates that, on any given day, approximately 840,000 people in the United States are homeless or living in temporary shelters. Approximately 3.5 million people in the United States will meet criteria for homelessness within a given year, and 1.35 million of them are children. It is estimated that 7.4 percent of U.S. residents, or as many as 13.5 million people in the United States, have been homeless at one point in their lives.

The majority of the homeless in urban areas are adult men of minority descent. In rural areas, however, the homeless are more likely to be Caucasian, and their genders and ages are less well known. Across both rural and urban settings, approximately 20 to 25 percent of the homeless adult population suffer from some type of severe and persistent mental illness. Although homelessness has been a historically significant phenomenon in the United States, it still remains difficult to cull reliable and comprehensive data about homeless individuals. Indeed given the difficulty of tracking and finding individuals who are homeless because of the variability in their locations, national data may significantly underestimate the incidence and prevalence of this social condition.

In 1987 the Stewart B. McKinney Homeless Assistance Act marked the first time the U.S. government acknowledged homelessness as a national crisis, despite its prevalence for decades prior to this event. In addition to designating federal money to help research and solve the problem of homelessness, the McKinney Act also provided a clear definition of homeless. According to the legislation, a “homeless” individual is one who lacks a fixed, regular, and adequate nighttime residence or has a primary nighttime residence that is a supervised publicly or privately operated shelter, an institution that provides temporary residence for individuals who will be institutionalized, or a public or private place not ordinarily used as regular sleeping accommodations for human beings.

The term homeless is inapplicable to individuals who are imprisoned or detained under congressional or state law. The concept as understood in the United States is largely based on an individual’s physical living arrangements or accommodations. However, as the literature suggests, this definition may be inadequate and unable to capture the complexity of phenomena internationally. Indeed this U.S. definition of homelessness reduces the concept to an issue of “houselessness,” which is a critical caveat to achieving an international understanding of the phenomenon.

The United Nations Centre for Human Settlements (Habitat) has refined homelessness and developed a more globally appropriate and responsive definition. The center also recognizes that definitions of homelessness vary widely and are influenced by geographic and socioeconomic factors. Most of what is known about homelessness, including an accepted definition of the construct, is based on the limited statistics and information available from European and North American countries and from the developing country of India. From this perspective, commonly held conceptualizations of homelessness include a consideration of social and familial relationships and sociodemographic factors.

Globally it is estimated that between 100 million and one billion individuals are homeless. Notably, however, homelessness data from developing countries are particularly sparse and difficult to collect. Across developed and developing countries, homelessness is often understood through both the narrow lens of accommodations, or lack thereof, and broader perspectives in an effort to inform services and interventions for those affected. For example, while some countries employ a typology based on characteristics of housing quality or on the length of time an individual is homeless, other countries may use a typology based on risk or potential of facing houseless conditions.

There are some emerging cross-cultural categories for understanding homelessness in an international arena. For example, supplementation homelessness, whereby an individual is homeless in response to migration, is quite different from survival homelessness, whereby individuals are homeless because they are searching for improved opportunities. Crisis homelessness, a precipitant of homelessness produced by a crisis (such as a storm, earthquake, or war) is quite different from the previous two. These categories focus more on the etiology for homelessness rather than on factors directly associated with the homeless individuals’ culture, race, or premorbid socioeconomic status.

From a global perspective, much attention is given to homeless children and adolescents, often referred to as street children. It was estimated that there were 100 million street children worldwide in 1992, with 71 million of these children working and living on the streets full-time, 23 million working and living on the streets part-time, and approximately 7 to 8 million abandoned. While street children are considered among the homeless, the literature makes clear distinctions between homeless adults and homeless children. The most accepted definition of a street child is “any girl or boy for whom the street (in the widest sense of the word, including unoccupied dwellings, wasteland, etc.) has become his or her habitual abode and/or source of livelihood; and who is inadequately protected, supervised, or directed by responsible adults” (Glasser 1994, p. 54).

Such a definition addresses characteristics in addition to physical living arrangements with a broader consideration of a child’s basic needs (that is, need for security and socialization). Similar to the various typologies used to understand global homelessness among adults, a typology has been developed by UNICEF that differentiates street children who live at home and those who do not, which is particularly relevant given that the majority of street children have some contact with their families.

Specifically the literature has found that there are experiential differences between street children who are deemed at high risk of homelessness (that is, the child spends some time in the streets), street children who are in the streets (for example, they spend most of their time in the streets, usually working), and street children who are of the streets (that is, the street is the child’s home). As with the typologies used with homeless adults, these categories may be useful in determining the level and the type of services needed.

Homelessness is an international crisis. The understanding of who is most affected and under what conditions as well as the ability to programmatically remediate the social ills that promote this condition are further limited by the national definitions that are often internally valid but not well generalized internationally.

Ennew, Judith, and Brian Milne. 1990. The Next Generation: Lives of Third World Children. Philadelphia: New Society Publishers.

Epstein, Irving. 1995. Dependency Served: Rhetorical Assumptions Governing the Education of Homeless Children and Youth. Paper delivered at the International Sociological Association Midterm Conference of the Sociology of Education Research Committee, Jerusalem, December 28.

Kuhn, Randall, and Dennis P. Culhane. 1998. Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization. American Journal of Community Psychology. 26: 207–232

National Law Center on Homelessness and Poverty. 2004. Homelessness in the United States and the Human Right to Housing. National Law Center on Homelessness and Poverty. http://www.nlchp.org/Pubs/index.cfm?FA=7&TAB=0.

U.S. Conference of Mayors. 2001. A Status Report on Hunger and Homelessness in America’s Cities. Washington, DC: U.S. Conference of Mayors.

U.S. Conference of Mayors. 2005. A Status Report on Hunger and Homelessness in America’s Cities. Washington, DC: U.S. Conference of Mayors. http://www.mayors.org/uscm/hungersurvey/2005/HH2005FINAL.pdf.

U.S. Department of Agriculture, Rural Economic and Community Development. 1996. Rural Homelessness: Focusing on the Needs of the Rural Homeless. Washington, DC: U.S. Department of Agriculture, Rural Housing Service, Rural Economic and Community Development.

Christopher L. Edwards

Crystal L. Barksdale

Cite this article Pick a style below, and copy the text for your bibliography.

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Homelessness

Encyclopedia of Public Health
COPYRIGHT 2002 The Gale Group Inc.

HOMELESSNESS

One of the most characteristic and consistent human behaviors over thousands of years is that humans build shelters. Homes offer protection from the elements and from a variety of health hazards and provide basic amenities such as a secure place to eat and sleep, to keep one's possessions, to raise a family, and be part of a community. Housing is a basic human need, yet the 1997 Human Development Report notes that more than 1 billion people—one-quarter of the world's population—live without shelter or in unhealthy and unacceptable conditions. Over 100 million people around the world have no shelter whatsoever. The health consequences of this level of homelessness are profound.

Homelessness is a matter of concern anywhere in the world, but it is a particular cause for concern—and shame—when it occurs in the richest nations in the world. Sadly, homelessness is a significant problem in both the United States and Canada. Accurate statistics on the level of homelessness are hard to come by. In part, this is because definitions of homelessness vary. It includes not only those who are living on the streets or in shelters and hostels but also those who are living in temporary accommodation or in housing that is unfit for human habitation. Estimates of the number of people without homes in the United States vary from 230,000 to 3 million, including between 50,000 and 500,000 children. The U.S. Department of Housing and Urban Development estimated in 1999 that "there are at least 600,000 homeless men, women, and children in the United States on any given night," adding that roughly one-third of this population is composed of families with children. In its 1997 position paper on eliminating homelessness, the American Public Health Association (APHA) noted that "as many as 7.4 percent of Americans (13.5 million people) may have experienced homelessness at some time in their lives." Homelessness increased in the 1990s, and the fastest growing segment of the homeless population was homeless families.

In Canada, it was estimated in 1986 that 130,000 to 250,000 Canadians were homeless or living in substandard housing, while a one-night census by the Canadian Council for Social Development in 1987 found 10,672 people in emergency shelters—undoubtedly an undercounting of the true homeless. Up to half of the homeless in Canada now are believed to be families with children.

A wide array of factors contribute to homelessness, but they can be thought of as falling into one of two categories: structural problems and individual factors that increase vulnerability. Structural problems include a lack of affordable housing, changes in the industrial economy leading to unemployment, inadequate income supports, the deinstitutionalization of patients with mental health problems, and the erosion of family and social support. Added to this are factors that increase an individual's vulnerability, such as physical or mental illness, disability, substance abuse, domestic violence, or job loss. Reducing homelessness will mean addressing issues such as these.

THE HEALTH EFFECTS OF HOMELESSNESS

The health effects of homelessness include higher rates of infectious diseases, mental health problems, physical disorders, disability, and premature death. A United Kingdom report noted that those sleeping on the street on average lived only to their mid-to-late forties. Higher rates of infectious disease result from overcrowding, damp and cold living conditions, poor nutrition, lack of immunization, and inadequate access to health care services. There has been a particular concern with increased rates of tuberculosis (TB), particularly multiple drug-resistant TB. It has been reported, for example, that 48 percent of the homeless in Toronto test positive for TB. Another factor leading to increases in TB and other infectious diseases is the higher prevalence of AIDS (acquired immunodeficiency syndrome) in those segments of the homeless population involved in drug abuse and prostitution.

The conditions in which homeless people live also make them more prone to trauma. A study of street people in Toronto found that 40 percent had been the victims of assault in the previous year, while 43 percent of the women reported sexual harassment and 21 percent reported they had been raped in the previous year. These street people were also more than five times more likely to have been involved (as pedestrians) in a motor vehicle accident than the general population, and one in twelve of them had suffered frostbite in the previous year.

Homeless people are also more likely to suffer from cardiovascular, respiratory, arthritic, gastrointestinal, and skin disorders. The Toronto study found that arthritis and rheumatism were twice as frequent, emphysema and bronchitis five times as frequent, asthma two and one-half times as frequent, gastrointestinal problems twice as frequent, and epilepsy six times as frequent as in the general population.

Mental health problems contribute to and result from homelessness. The United Kingdom report noted that 9 to 26 percent of those living on the street have serious mental health problems (compared to 0.5 to 2% in the general population), while Canadian estimates are that 20 to 40 percent of those using shelters have substance abuse or psychiatric problems. Alcohol abuse and dependency is also very common in this population. But while such substance abuse and mental health problems contribute to homelessness, homelessness also contributes to these problems. The Toronto study, for example, found that one-third of the street people interviewed had feelings of worthlessness, that more than one in four (and almost two-thirds of the women) had contemplated suicide in the past year, and that one in twelve (and almost one in three of the women) had attempted suicide in that same period.

The increase in homelessness among families in recent years has focused increasing attention on the serious health problems faced by children living in hostels and temporary accommodation. These problems include disturbed sleep, mood swings, depression, and developmental delays, as well as increased rates of obesity, anemia, infections, injuries, and other health problems.

HEALTH SERVICES FOR THE HOMELESS

Not surprisingly, given all their health problems, homeless people make significant demands on the health care system. The Toronto study found that in the previous year, two-thirds of street people had seen a physician, more than half had used emergency rooms, and one-quarter of them had been admitted to hospital. But at the same time, homeless people—both those living on the street and those living in hostels and temporary shelters— experience significant barriers in accessing care. These barriers include procedural barriers such as the need to have a home address or a health card, economic barriers in terms of purchasing necessary medications, medical supplies, or appropriate foods, and—perhaps worst of all—prejudice and rude treatment on the part of health care providers. It is particularly unfortunate that a group that is so vulnerable and has such high needs should suffer further indignity and prejudice from what are supposed to be the caring professions.

Homelessness is a significant public health and health care issue. But more than that, as the APHA position paper concludes, "The persisting numbers of homeless people in America are an indictment of our collective failure to make basic ingredients of civilized society accessible to all citizens."

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Homelessness

Encyclopedia of Food and Culture
COPYRIGHT 2003 The Gale Group Inc.

HOMELESSNESS

HOMELESSNESS. No nation is without its homeless. In the United States alone, between 280,000 and 600,000 men, women, and children are homeless each night, according to differing estimates. They are without permanent lodging because of poverty, lack of affordable housing, low wages, substance abuse, mental illness, or domestic violence. In many other countries, however, civil unrest, war, and famines bring about homelessness. At the beginning of the twenty-first century, there were more than eleven million homeless worldwide.

Paramount among the problems facing the homeless are poor nutrition and hunger. They can be life-threatening, especially among refugees. Protein-energy malnutrition is a major contributory cause of death among newly displaced refugees. International relief organizations and the United Nations set up refugee camps and make the distribution of nutritionally adequate food rations a high priority. The homeless in the United States often do not experience such extreme food deprivations. However, many are often chronically undernourished. Compared to other groups at risk for hunger, the homeless are at greatest risk, being ten times more likely to go without food for a day compared to the poor. Few are able to obtain three meals a day, and many go at least one day a month without any food. Scant research indicates that many have caloric intakes far below recommended levels and may have inadequate intakes of calcium, folacin, iron, magnesium, or zinc. Their low-calorie diets, which tend to be high in fat, cholesterol, and sodium and inadequate in essential nutrients, may further compromise the already poor health status of the homeless.

While many rely on homeless shelters, especially in winter months, a large number find refuge in cars, abandoned buildings, on grates, in parks, or, other outdoor places. Most have been without a fixed and regular nighttime residence for more than one year. Lacking a stable home environment and cooking and storage facilities exacerbates their inability to obtain an adequate, varied, and
healthy diet. While it is not uncommon to see a homeless person panhandling or scavenging for food through trash cans, most depend on soup kitchens and shelters for the major portion of their daily nourishment. Soup kitchens and shelters typically serve one meal a day on-site, although some shelters permit their residents to prepare and cook their own meals. Those who are substance abusers or have mental health problems are more likely to resort to obtaining food from trash cans or begging, compared to those without these health conditions.

Participation in the Food Stamp Program, the government's largest antihunger program, is unusually low among the homeless. While homeless advocates speculate that most of the homeless are eligible, they argue that barriers such as documentation of identity or administrative burdens prevent many from participating. The difficulty of making effective use of food stamp benefits without adequate cooking and storage facilities is also a barrier. While the Food Stamp Program does permit states to contract with restaurants to serve meals at concessional prices to the homeless, such authorizations are uncommon among states.

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homelessness

The Columbia Encyclopedia, 6th ed.

Copyright The Columbia University Press

homelessness, the condition of not having a permanent place to live, widely perceived as a societal problem only beginning in the 1980s. Figures for the number of homeless people in the United States are imprecise, but it was estimated that 700,000 people were homeless per night in the late 1990s and 610,000 per night in the early 2010s. A survey made in 1994 found that 12 million Americans had experienced homelessness at some point in their lives. The vast majority of those who are homeless consists of single men and families with children. The problem exists in all major cities and many smaller communities. The causes range from large-scale deinstitutionalization of mentally ill people to disintegration of the social fabric in minority communities, drug and alcohol abuse, relatively stagnant wages at lower income levels, cutbacks in federal social-welfare programs, job loss, reductions in public housing, and rent increases and real-estate speculation. The McKinney-Vento Homeless Assistance Act (1987) established federal support for the building and maintenance of emergency homeless shelters. The Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act (2009) focused greater emphasis on homelessness prevention and continuing efforts to eliminate chronic homelessness. Among the efforts to reduce chronic homelessness, which involves people with disabling behavioral or health conditions who experience repeated or prolonged periods of homelessness, is the Housing First program, which emphasizes placing in homeless into housing with some support before requiring. for example, treatment for addiction; the program represents a reversal of the typical earlier approach.

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Homelessness

Homelessness is the condition of having no fixed, adequate, or secure place to live. In many, though not all cases, homelessness may be a result of mental illness, abuse, or addiction. Even when there is no associated mental health problem, those who are homeless may suffer emotionally because of the lack of the most basic of human needs: safe shelter.

Young people can become homeless too. Some teenagers become homeless with their families when financial problems force them from their homes. Other young people become homeless when they run away from home because of abuse, neglect, or indifference on the part of their families.

The median age of runaway children is between 14 and 16 years.

About 2.8 million young people living in U.S. households report that they ran away during the previous year.

Approximately 300,000 people younger than 18 are homeless and on their own each year.

Young people unaccompanied by parents account for about 3 percent of the homeless in cities.

Jon and Ryan went for a bike ride one day and were astounded to discover a group of people living in cardboard boxes at the edge of the county park. Before this, it had never occurred to them that at the edges of their suburban community were people who lived on the streets, dependent on social service agencies, charities, friends, and their own ingenuity to find shelter.

The number of people in the United States who are homeless is difficult to estimate because the population of homeless people is constantly changing as some people find housing and others are displaced. One 1999 estimate by the U.S. National Law Center on Homelessness and Poverty indicated that about 700,000 people were homeless on any given night and that over a one year period about 2 million people had experienced a period of homelessness. A study conducted in 1996 by the U.S. Census Bureau for the Department of Housing and Urban Development (HUD) showed that about 70 percent of people who are homeless can be found in cities, about 21 percent in suburbs, and about 9 percent in rural communities.

Homelessness can be either temporary, lasting only a few days or weeks, or semi-permanent, lasting for several years. The number of people who are without shelter is affected by many social factors, including the number of jobs available, the cost of housing, the cost of basic necessities such as food, and the availability of social outreach and assistance programs. Of the homeless people in the HUD study, about 15 percent were members of a homeless family and 85 percent were single adults. However, a 1998 study by the U.S. Conference of Mayors found that families made up 38 percent of the people experiencing homelessness, which suggests that the number of families without shelter is increasing. Seventy-seven percent of single adults who were homeless were men, whereas a woman headed the majority of homeless families (84 percent).

In general, people are more likely to be homeless if they are between the ages of 25 and 54, have less than a high school education, belong to a racial minority, have a history of mental illness, and have experienced domestic violence or abuse. Other factors that increase the risk of becoming homeless include having lived in foster care or a group home as a child, childhood physical or sexual abuse, childhood experiences of homelessness, running away from home, and a history of drug or alcohol abuse.

Most people who are homeless have no health insurance and little access to medical care. In the HUD study, almost half of homeless people surveyed had chronic (long-term) health problems such as diabetes*, cancer*, high blood pressure*, or arthritis* for which they were not receiving treatment. Another quarter of the homeless population had an infectious disease such as pneumonia*, tuberculosis*, or AIDS*. In addition, a very high proportion of people who are homeless have problems with drugs, alcohol, and/or mental illness. Almost none of these people receive treatment for their physical or emotional problems. Many people experiencing homelessness also become victims of crime while living on the streets.

is short for acquired immunodeficiency (im-yoo-no-de-FISH-un-see) syndrome, the disease caused by the human immunodeficiency virus (HIV). It is characterized by the pro-found weakening of the body’s immune system.

The most common programs available to help people who are homeless provide food (e.g., soup kitchens, food pantries) and emergency shelter. Although many people who are homeless are eligible for government programs such as Medicaid, food stamps, veterans’ benefits, or welfare benefits, they often have difficulty claiming these benefits because they have no fixed address or lack the organizational skills necessary to follow through with these programs. Not all people experiencing homelessness are unemployed. In the HUD survey, 44 percent of those interviewed reported that they had done some paid work in the past month. Other sources of cash included gifts from friends and families, money collected panhandling, and money from illegal sources such as drug dealing and prostitution.

Reducing homelessness is the target of many social programs. Studies suggest that the most effective programs not only help people find places to live, but also help people solve the underlying problems that led to their homelessness in the first place.

The Salvation Army, a Christian organization founded in London in 1878, provides food, shelter, and clothing for people needing aid, such as the homeless and the elderly. Their care has since spread throughout the United States, as well as other countries of the world. Visuals Unlimited

Books

Eighner, Lars. Travels with Lizbeth: Three Years on the Road and on the Streets. New York: St. Martin’s Press, 1993. The true story of a homeless person’s survival on the streets with his dog, Lizbeth.

Neufeld, John. Almost a Hero. New York: Simon and Schuster, 1995. A fictional story about a twelve-year-old’s experience with homeless children.

Bolnick, Jamie Pastor, and Tina S. Living at the Edge of the World: A Teenager’s Survival in the Tunnels of Grand Central Station. New York: St. Martin’s Press, 2000. The true story of Tina S., a runaway who survived a year of homelessness in New York and who now helps others who are without shelter.

Organization

National Coalition for the Homeless, 1012 Fourteenth Street, NW, #600, Washington, D.C. 30005-3410. The National Coalition for the Homeless is a national advocacy network for homeless persons and providers of services to end homelessness. Among other services, the organization publishes fact sheets about homelessness and updates about legislation and government policies that affect the homeless. Telephone 202-737-6444 http://nch.ari.net

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homeless

home·less
/ ˈhōmlis/
•
adj.
(of a person) without a home, and therefore typically living on the streets:
the plight of young homeless people |
[as n.] (the homeless)
charities for the homeless.DERIVATIVES:home·less·ness
n.

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Homelessness

In the United States, definitions of homelessness help determine who is able to receive shelter and assistance from certain health and social service providers.

The Stewart McKinney Homeless Assistance Act of 1987 defines a homeless person as any individual who lacks housing, including an individual whose primary residence during the night is a supervised public or private facility that provides temporary living accommodations or an individual who is a resident in transitional housing. More specifically, this means an individual who lacks fixed, regular, and adequate nighttime residence, and an individual who has a primary nighttime residence that is either (i) a supervised temporary living shelter (including transitional housing for the mentally ill), (ii) an institution that provides temporary residence for individuals intended to be institutionalized, or (iii) a place not designed for or ordinarily used as a regular sleeping accommodation for human beings.

Homelessness is an acute version of residential instability, which can be compared or contrasted with definitions of poverty. Thus the term “homeless” may also be extended to include people who have nowhere to go and are at imminent risk of losing housing through eviction or institutional discharge. Some definitions of homelessness further specify the duration of time without regular and adequate residence, or the types of temporary living shelter or institutions that are not fixed residences. People who live without alternatives in overcrowded or unhealthy housing conditions may be at risk of homelessness. Worldwide, national and cultural groups may have variable and often different definitions of homelessness, different terms for the condition of being without housing, and different definitions of adequate housing. For all of these reasons related both to methods of counting and varying definitions, estimating the size of the homeless population is extremely difficult.

The history of homelessness is intertwined with the history of poverty in the United States. Poverty has always been problematic for humanitarian reasons and because it conflicts with the ideal of prosperity for all. Social welfare, based on individualistic ideas of deserving and undeserving poor, has improved society but not eliminated persistent poverty or homelessness. The 1960s war on poverty was a widely shared value, but in the 1980s concern about homelessness was confounded by moral evaluations of individual behaviors. While many in the United States have been poor or come from poor families, fewer have experienced homelessness. Therefore, the collective understanding of homelessness in the United States is limited in ways that the understanding of poverty is not.

Homeless adults are poor and have high rates of unmet need for health care. This is in part because poverty is associated with higher risk and rates of illness, particularly mental illnesses including substance abuse. Homeless people experience disproportionate rates and symptoms of mental health disorders, including substance abuse disorders and dual diagnoses. For these reasons, large portions of federally funded homeless services are medical services, and homeless people are often viewed according to their present or past medical classifications.

Studies researching the incidence, distribution, and control of a disease in a population (known as epidemio-logical studies) find that between one-third and one-half of homeless people have mental health disorders and approximately two-thirds have either a mental health or substance use disorder. People with severe mental illness are likewise more likely to become homeless, particularly when the disorder is co-morbid (co-occurs) with substance abuse. For this reason, changes in rates of homelessness are often associated with changes in mental health care and hospitalization policies.

Mental illnesses compound the vulnerability and needs of homeless adults, as reported by the Surgeon General. Psychiatric disorders exacerbate many types of problems, including housing instability, morbidity (disease), and mortality (death). Psychiatric disorders and lack of stable living conditions complicate general health care for homeless adults.

Methods for estimating the size of the homeless population are evolving and sometimes contested, and are complicated by varying definitions of homelessness. The U.S. Census, while attempting to identify the number of people who are homeless and who use particular types of homeless services, has complex and service-based definitions of homelessness. It also has recognized its limited abilities to define and enumerate the homeless (it is after all a national household survey). In 2000, the Census Bureau defined the Emergency and Transitional Shelter (E&TS) population by surveying people who use a sample of homeless services. They counted homeless people in emergency shelters for adults, runaway youth shelters, shelters for abused women and their children, soup kitchens, and certain outdoor locations. Technically, however, homeless people may reside in “E&TS,” in foster care, in jails and prisons, in group homes , in worker dorms, non-sheltered in the outdoors, doubled up with families or friends, or temporarily in Census-recognized households. According to the National Coalition for the Homeless, while counting the number of people who use services such as shelters and soup kitchens can yield important information about services, applying these numbers toward estimating numbers of homeless people can result in underestimates of homelessness.

Further complicating the issue of counting homeless people is the fact that, in many cases, homelessness is a temporary condition. Because of this fact, some researchers advocate a method of counting all the people who are homeless in a given week or, alternatively, over a given period of time. However, the numbers of people who find housing and the number of people who newly find themselves homeless fluctuates over time periods. In contrast, people with mental illness or substance abuse problems tend to be chronically without homes—it is difficult for many of these people to find permanent housing. Thus, while these two time-oriented methods of counting homeless can be useful, they too have statistical problems—they can overestimate the numbers of homeless people.

Census estimates of the size and composition of the homeless population are difficult to create, for reasons described above. The Emergency and Transitional Shelter (ET&S) Population count in the United States in 2000 was 170,706. However, this figure does not include homeless adults not using ET&S services, sampling error, or some groups of homeless people not enumerated in the ET&S count. The ET&S population in 2000 was 61% male and 74% adult. Among the 26% who were youth, 51% were male. For adults, the population was 65% male, 41% were white, 40% were African American, 20% were Latino of any race, 2% were Asian, 2% were Native American, and 9% were one other race alone.

Another estimate of homelessness is a 2007 report by the National Alliance to End Homelessness, which estimated that 744,313 people were homeless in 2005. Forty-four percent of those people were unsheltered, and 56% were sheltered. Forty-one percent of the homeless were families.

The large variation between these estimates illustrates that, as the National Coalition for the Homeless states, “By its very nature, homelessness is impossible to measure with 100% accuracy.”

Causes

People with mental illness are at higher risk for becoming homeless due to challenges associated with deinstitutionalization and transition planning, and both poverty and disability associated with mental illness.

Social research has studied the causes and consequences of homelessness, surveying homeless people, examining entrances into homelessness, exits from homelessness, and effects of homelessness on health and well-being. Promising explanations for increasing rates of homelessness in the 1980s have included mental disability and illness, lack of social support through jobs and marriage, increased use of drugs and alcohol, and the erosion of low-income housing in urban areas. These explanations mirror the processes of deinstitutionalization in mental health policy, unemployment, addiction and abuse, and urban decay. In other words, a direct correlation can be demonstrated between policies and trends and the rates of homelessness. As deinstitutionalization occurred, for example, the number of mentally ill people without homes increased.

Consequences

Consequences of homelessness include the exacerbation of problems that may have caused homelessness. Homeless people have reduced access to housing, jobs, health care, and basic needs like food and clothing. Isolation and lack of social support are well-documented aspects of homelessness, particularly for homeless people living with mental health or substance abuse disorders. Homeless women and men have been found to have significantly less family support than never-homeless women and men. Disaffiliation from family often limits opportunities for recovery and prevention.

Services for homeless people can be divided into those providing medical care, those providing housing, and those providing other basic needs. Publicly funded agencies provide the majority of medical care, especially primary and mental health care. Public and private organizations share the responsibilities of providing shelter and housing services, through both large federal programs and smaller need and faith-based programs. Private agencies deliver most other daily needs to homeless people, through food pantries, soup kitchens, and other charities. Limited data exists on vocational services for homeless adults.

Title VI of the McKinney Homeless Assistance Act of 1987 created the Health Care for the Homeless (HCH) program, authorizing federal funds for primary and mental health care to homeless people. Title VI authorizes several programs to provide a HCH program, a Community Mental Health Services block grant program, and two demonstration programs providing mental health and alcohol and drug abuse treatment services to homeless people. HCH funds support providers who offer mental health, case management , and health education services, as well as substance abuse treatment. In 1987, 109 grants were made for homeless health services with $46 million. In 1992, the Act was amended to include homeless and at-risk children, creating a medical home and source of health insurance for young people. In 2005, Congress appropriated $145 million for health care for the homeless grants. The HCH program is the largest single effort to address the medical needs of the homeless. Each year, the HCH Program serves almost 600,000 clients in the United States To be a HCH service agency requires cultural and linguistic competencies, compassionate community outreach, and providers who reflect the community they serve.

The federal Center for Mental Health Services oversees Projects for Assistance in Transition from Homelessness (PATH) grant program. PATH provides state funds in support services to individuals who are homeless or at risk of becoming homeless and have serious mental illnesses. These funds amounted to more than $52 million allocated to 463 providers in 2005. States contract with local agencies and nonprofit organizations to provide an array of services, including outreach, support services, a limited set of housing services, and mental health treatment.

There are several obstacles or barriers in providing health care to homeless people. First, homeless or persistently poor people may be concerned about their work and sustenance, devaluing their own medical needs. Alienation and depression among the homeless can also be an obstacle to providing care. There can be mutual communication problems between providers and patients. Providers may lack cultural understanding that eases work with homeless clients. Finally, lack of preventive maintenance of medical care by the homeless may result in expensive and extensive needs for care, including hospital care, which may stress the capacities of certain service providers.

Homelessness is both a form of poverty and an acute condition of residential instability. Homelessness is compounded by behavioral problems, mental health policy changes, disparities in health and health care, racial inequalities, fluctuations in affordable housing, and lack of social support. Overly individualistic views and explanations of homelessness do not reflect its multiple causes and effects. Like all groups, homeless people are diverse, experiencing and exiting homelessness for a myriad of reasons. Services for homeless adults likewise reflect a variety of needs and experiences. Nonetheless, homelessness remains a national and international concern, particularly in urban areas, for the twenty-first century.

KEY TERMS

Deinstitutionalization — The process of moving people out of mental hospitals into treatment programs or halfway houses in local communities. With this movement, the responsibility for care shifted from large (often governmental) agencies to families and community organizations.

There are many ways that Americans can support community and federal efforts to help homeless people living with mental illness. Some strategies include:

support collective public and private efforts to build homes and provide health care for people with unmet medical needs.

become educated about the challenges faced by homeless and mentally ill people in American society.

stop the practice of equating people in poverty and with illness with their medical conditions, instead of recognizing them as human beings. Succeeding in this step could open doors for recovery of health and housing without demeaning the humanity of people in need.

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Homelessness

Homelessness

In the late twentieth century, homelessness became a serious issue in the United States. Increased numbers of men and women were living in shelters or on the street. Many viewed homelessness as a condition caused by excessive drinking and drug abuse. Although this view has a long history in American life, the picture is in fact more complicated. Other factors besides alcohol and drug abuse have contributed to the problem of homelessness in modern society.

A Historical Background of Homelessness

The word "homeless" can be understood in two ways. In its most literal meaning, "houseless," the word has been used to describe people who sleep outdoors or who live in temporary housing. In earlier generations, a homeless person was often a hobo, and the local police station was the most likely place to find temporary housing. In the second meaning of the word, "homeless" describes someone who lacks a sense of belonging to a particular place and who has little or no connection to a community.

In the rural- and small-town society of the nineteenth century, family was strongly linked with place. Home was the basis for community and social order, and traditions of people helping each other and joining together to control troublesome behavior grew out of this sense of place. To be homeless was to be unattached, outside this web of support and control. It was also to be without the resources necessary for living. Many of the young men and women who moved from farm to city, or those who emigrated during the nineteenth and early twentieth centuries, were unattached in this respect. In fact, such groups as the YWCA, YMCA, and various ethnic organizations were established both to help and oversee these "homeless" people.

By the 1840s, it was common for Americans to link homelessness with a habit of drunkenness. In the popular view, drunkards, usually men, drank up their wages and impoverished their families; they lost their jobs and their houses, and drove off their wives and children by cruel treatment. They became outcasts and drifters, and their wives entered poorhouses while their children became inmates of orphanages. By the 1890s, the public held the same ideas about people who abused drugs such as opium, morphine, and cocaine and the unhappy circumstances of their families.

The Effect of Homelessness on the Economy

Homelessness in the United States has often been the result of conditions beyond the control of the individuals themselves. Studies of homelessness prior to the Great Depression noted that the numbers of homeless people went up and down depending on economic conditions. Severe problems with the United States economy in the late- nineteenth and early-twentieth century caused large numbers of people to lose their jobs and thus their financial security.

Scholars investigating the problem of homelessness before the depression also noted the importance of employers' decisions about hiring and firing. When the economy soured, workers without families to support and workers seen as the least productive were the first

[Image not available for copyright reasons]

to be fired. For example, employers assumed that single young women would be supported by their families and that married women did not really need a second income. Older men, single men known to drink heavily, and members of ethnic or racial minorities were more often marked for layoff. By contrast, in boom times employers relaxed their standards for hiring and job performance. All but the most seriously disabled, and the most unreliable heavy drinkers and drug users, could find some kind of work. As a result, when the economy was good, the numbers of the homeless shrank.

Working Conditions and Health Care

Pre-depression observers also emphasized the impact of other factors on homelessness, including working conditions, the health and strength of the worker, and the lack of government support for people who lost their income. Working conditions were often dangerous, and diseases such as tuberculosis affected large numbers of people. Many men became disabled by disease or workplace accidents, often at a young age. There was not much in the way of welfare to support people when they had lost their jobs. In addition, medical treatment at the time was often ineffective. As a result, these men rapidly sank into terrible poverty. They were forced to beg, find a meal at soup kitchens, and sleep in shelters or the cheapest lodgings infested with vermin. (These lodgings came to be called "flophouses.") Some of these men were heavy drinkers, and some were drug users. But these problems often grew out of the conditions of poverty and rootlessness.

Scholars of homelessness also realized that the urban areas where homeless people clustered, as well as the businesses—both legal and illegal—they were involved in, reinforced a homeless way of life. In these areas, called "hobohemias" before the depression and later "skid row," the poor and the homeless could find cheap restaurants, saloons, residential hotels and lodging houses, private and eventually public welfare agencies, and agencies that listed opportunities for "day" work. They could also find a flourishing drug trade in many corners of skid row.

By the 1940s, skid row was where poor single men disabled by age, injury, and/or chronic illness wound up. They survived on private charity, small allowances from public welfare, modest pensions, and a bit of income from odd jobs. It is important to note that these men were not homeless in the sense of having no place to live. However, they were homeless in the sense of remaining outside the bounds of society. Contrary to popular belief, only a minority—perhaps one-third—were heavy drinkers and drug users.

New Government Programs and Policies

The period from 1941 to 1973 was a time of prosperity in the United States. During the same period, the government increased welfare programs, such as Medicare, affordable housing, and benefits for the disabled. New programs to help heavy drinkers and drug users were created, and local governments began investing in projects to clean up urban areas and give new life to cities. Many observers believed that skid row would disappear.

One important result of these changes was to improve the economic circumstances of the elderly. Today, very few of the homeless are elderly. Other results were not as people had hoped. Some cities bulldozed their skid-row area. But the people driven out of skid row did not go on to find other, better housing or better lives. In fact, homelessness became a literal condition: the poor had no houses to live in.

In the early 1980s the media began to report on a new generation of younger homeless people. These people appeared to have high rates of mental illness, heavy drinking, and drug use. As a result, many observers explained the new homelessness as a result of policies that concerned mental hospitals and imprisonment for public drunkenness and minor drug offenses. During the 1960s and 1970s many states "deinstitutionalized" both mentally ill people and alcoholics and addicts. In other words, large numbers of state hospital patients were released. New laws made it much harder to commit a person involuntarily to a mental institution.

Many states also "decriminalized" public drunkenness. People who were drunk in public were sent to places where they could sober up rather than to jail. Similarly, many minor drug offenders were kept out of jails. Homelessness was described by many as a condition in which troubled and troublesome people found themselves. They were not only houseless, they were barred from institutions that had once sheltered them.

Current Situation

Some recent studies of homelessness continue to claim that perhaps 85 percent of homeless people are substance abusers and/or mentally ill. However, these studies have a serious flaw. Their estimates of substance abuse and mental illness rely on measurements of lifetime substance abuse, rather than measurements of current substance abuse. A measure of whether a person has ever had a severe mental illness or substance abuse disorder will always produce much higher rates than a measure of a current disorder (defined as occurring within the previous six months or one year of the study).

Probably a more accurate estimate, provided by the Substance Abuse and Mental Health Services Administration, is that about a third of the homeless people in the United States have serious mental illness, and more than half also have an alcohol and/or drug problem. The proportion is much higher among single men and much lower among adults who are homeless in family groups, most often single women with children.

Heavy drinking, drug use, and mental illness are certainly risk factors that make it more likely that some people will become homeless. Yet clearly most people with such problems never become homeless. To explain homelessness, then, other risk factors must be considered as well. These factors were first discussed a century ago, and still apply to the modern problem of homelessness. These factors include changes in the economy, the supply of available and affordable housing, the availability of support systems such as welfare and medical care, and whether a person has the support of his or her family.

An additional factor contributing to homelessness in the late- twentieth century was the size of the baby-boom generation. The risk for developing mental-health, alcohol, and drug problems is greatest between the ages of 18 and 25. The huge baby-boom generation reached this age at the same time as the supply of jobs, housing, and other material goods was becoming scarce.

Changes in the Economy. Changes in the economy have increased the number of highly skilled, well-paid technical jobs (such as those in the field of computers) and low-skilled, poorly paid service jobs (such as those in the fast-food industry). At the same time, these changes have reduced the number of semiskilled, well-paid jobs in the field of manufacturing. This shift from a manufacturing to a service economy is known as deindustrialization. Hardest hit by this shift are the younger members of the huge baby-boom generation (born between 1946 and 1964), especially Hispanics and African Americans. People in this group may lack the advantage of higher education or advanced technical training when they try to find work. They are not qualified for highly skilled work but cannot make a decent living in service jobs. People who work for low hourly wages are sometimes called the "working poor." Although many of these people work very hard, they remain poor and vulnerable to losing their housing.

Housing. Along with changes in the job market, the cost of rental housing rose sharply in the 1980s. The amounts of aid given by federal and state welfare programs and unemployment insurance did not rise enough to meet these costs. As a result, it became increasingly difficult for poor families to establish and maintain households.

The 1990s were a time of economic growth. However, this prosperity did not lessen the problem of homelessness. The general prosperity of the decade had little effect on the poorest members of society. In addition, economic expansion usually has the effect of increasing rents. The number of low-rent apartments decreased by 13 percent from 1996 to 1998. At the same time, the Department of
Housing and Urban Development provided assistance to fewer households. The crisis in affordable housing became worse during the great boom.

People with serious mental illness are overrepresented among the homeless population. While only 4 percent of the U.S. population has serious mental illness, five to six times as many people who are homeless (20–25%) have serious mental illness, and many more have milder forms of mental health problems. The reasons for this over- representation are complex. Some mentally ill people are homeless because they were released from institutions or hospitals, or have not been hospitalized despite a need. Moreover, since they have trouble keeping a job, they are often poor or financially unstable, and they receive little or no health care. Thus, their symptoms are often active and untreated, making it very difficult for them to negotiate meeting basic needs for food, shelter, and safety. Up to half of the mentally ill homeless also have substance use problems, which can make it harder to obtain a stable living situation. Also, according to the National Resource Center on Homelessness and Mental Illness, people with serious mental illnesses have greater difficulty exiting homelessness than other people. They are homeless more often and for longer periods of time than other homeless subgroups. Many have been on the streets for years. Numerous government and private agencies have proposed plans to reduce and eventually prevent the problem of homelessness among the mentally ill, but progress will likely be slow.

Conclusion

Every night in the United States, about 750,000 people are homeless. In a year, between 2.5 million and 3.5 million people experience homelessness for some period of time (days to months). Among people who remain homeless for long periods, rates of heavy drinking and drug use are very high. It is not the case, however, that drinking and drugs directly cause homelessness. Drinking and drug use may cause health problems and troublesome behavior, such as criminal activity. These health and behavior problems contribute to job loss, loss of family support, or loss of housing. Problems in the economy worsen these circumstances. In addition, far fewer people who need care and treatment for mental-health and addiction problems can turn to institutions as a place to live during recovery. As a result of many factors other than drinking and drugs, the homeless became a visible problem on the streets of American cities.

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Homelessness

Encyclopedia of Sociology
COPYRIGHT 2001 The Gale Group Inc.

HOMELESSNESS

Literal homelessness—lacking permanent housing of one's own—is a condition that has been present throughout human history. It has always been dangerous as well, given the necessity of shelter for survival. Nevertheless, the routine occurrence of homelessness in the past probably prevented the problem from generating any extraordinary degree of collective concern. Members of premodern societies often experienced losses or disruptions of residence as a result of food scarcity, natural disaster, epidemic disease, warfare, and other environmental and self-inflicted circumstances. Such forces contributed to the likelihood, if not the expectation, that most people would be homeless at some point in the life cycle.

Ironically, now that homelessness is relatively rare in Western societies, it has achieved a special notoriety. When shelter security becomes the norm, the significance of housing evolves beyond the purely functional. Homes, like jobs, constitute master statuses, anchoring their occupants in the stratification system. Hence, being without a home portends a more general and threatening disaffiliation, defined as "a detachment from society characterized by the absence or attenuation of the affiliative bonds that link settled persons to a network of interconnected social structures" (Caplow et al. 1968, p. 494). This is the broadest meaning associated with the concept of homelessness, at the opposite end of the continuum from its literal definition.

Homelessness, broadly construed, first appeared on the American scene during the early stages of colonial settlement, with paupers, indentured servants, petty criminals, unemployed seamen, and the mentally impaired forming a pool of individuals at risk of vagrancy. It began to assume major proportions as a social problem in the United States near the end of the nineteenth century. Over the several preceding decades, urban homeless populations had emerged in response to a series of events at the national level, including Civil War displacement; the arrival of impoverished European immigrants; seasonal employment patterns in agriculture, construction, and the extractive industries; and severe economic setbacks in the early 1870s and 1890s (Rooney 1970).

As a makeshift remedy, downtown warehouses and old hotels were converted into inexpensive, dormitory-style lodging facilities. The proximity of the lodging facilities to one another, along with the distinctive mix of commercial and recreational establishments growing up around them, helped to concentrate the homeless physically in areas that came to be known as skid rows (supposedly named for a "skid road" in Seattle used to slide logs downhill). At the turn of the century, these areas were less burdened by the seedy images later evoked by the term "skid row." Instead, they were vibrant neighborhoods offering a temporary resting place and a range of services to thousands of tramps, the mobile workers who laid the foundation for the U.S. industrial economy.

The manpower needs created by World War I subsequently drained skid row districts, but a pool of footloose veterans replenished them at war's end. An even greater surge in homelessness—one extending well beyond the boundaries of skid row—was soon sparked by the Great Depression. The widespread hardship of the period forced previously domiciled individuals into a migrant lifestyle, and shantytowns (dubbed "Hoovervilles") sprang up in urban and rural settings alike. These new manifestations of homelessness in turn stimulated the first generation of sustained research on the subject among sociologists. Anderson (1940), Sutherland and Locke (1936), and other scholars conducted studies of different segments of the homeless population as part of the Depression-era relief effort.

A second generation of research started in the 1950s. Large-scale single-city surveys—many of which were funded by urban renewal agencies—informed the debate over what to do about deteriorating skid row areas (Bahr and Caplow 1974; Bogue 1963). Demographic data obtained during the surveys showed homeless respondents to be predominantly male, white, single, older, and of local origins. The surveys also lent credibility to the popular view of the homeless as deviant "outsiders." Depending on the city under examination, between one-fourth and one-half reportedly were problem drinkers, a higher percentage had spent time in jail or prison, most were unable or unwilling to hold down steady employment, many suffered from poor health, and few were enmeshed in supportive social networks. This negative profile based on the survey findings was countered by a parallel body of ethnographic evidence. Field observers like Wallace (1965) portrayed the homeless of skid row in subcultural terms, as a cohesive group with their own language, norms, and status hierarchy. Participation in the subculture was believed to help members cope with a problem more serious than their presumed deviance: extreme poverty.

In the 1970s, almost a century after skid row became a recognizable entity in the American city, its demise seemed imminent. Urban renewal and redevelopment projects had eliminated much of the infrastructure of skid row, while slackening demand for short-term unskilled labor was eroding one of the few legitimate economic roles the area could claim to play. Consequently, several investigators predicted skid row's disappearance and, by implication, the decline of the U.S. homeless population (Lee 1980). Yet within a decade of such forecasts, homelessness had resurfaced as an important national issue. During the 1980s media coverage of the so-called new homeless increased dramatically, and federal legislation (most notably the McKinney Act) was formulated to address their plight. The amount of social scientific inquiry rose as well. Indeed, the recent outpouring of scholarly monographs on the topic has surpassed that of any prior generation of research.

Despite this renewed interest, what is known about contemporary homelessness remains limited, for several reasons. Unlike most groups surveyed by sociologists, the homeless are not easily reached at residential addresses or telephone numbers. The demolition of skid row districts in general and of single-room-occupancy (SRO) hotels in particular, accompanied by social control measures designed to reduce the public visibility of drunks, panhandlers, and other "undesirables," has intensified the difficulties involved in finding homeless people, pushing a higher percentage of them into more dispersed, obscure locations. Those referred to as the doubled up, who stay with settled relatives or friends, are virtually inaccessible to investigators. Also poorly captured by surveys are the many individuals for whom homelessness is of brief duration or episodic in character. Even among the homeless who can be found, participation rates fall far short of perfect. The prospect of further stigma and humiliation keeps some from admitting their condition, thus excluding them from sample membership, while others are too suspicious or incoherent to take part in an interview.

Finally, the political context surrounding the latest wave of research magnifies the significance of each methodological obstacle just identified. Because the homelessness issue has been transformed into a referendum on the ability of the state to meet its citizens' needs, liberals and conservatives both use the slightest technical shortcoming as ammunition with which to attack any study unfavorable to their own position. Similarly, members of both camps—not to mention the media, advocacy groups, government agencies, and other actors—selectively draw on research results to frame the homelessness problem in a way that attracts (or diverts) public attention. Thus, apparently straightforward "facts" about homelessness—and there are few of these to begin with—become matters open to debate.

"Snapshot," or single-point-in-time, data on the size of the national homeless population illustrate the uncertain nature of the existing knowledge base. According to an early assertion by advocates, the number of homeless in the United States as of 1982 stood at 2.2 million, or approximately 1 percent of the total population of the country (Hombs and Snyder 1982). However, only two years later the U.S. Department of Housing and Urban Development (HUD) (1984) compiled a series of estimates, extrapolated from street counts and surveys of informants and shelter operators, that yielded a "most reliable" range of 250,000 to 350,000. A 1987 Urban Institute study arrived at a figure—500,000 to 600,000 homeless nationwide on a single day—that fell between the advocate and HUD extremes (Burt and Cohen 1989). More recently, the Census Bureau enumerated 240,000 homeless people in the course of its massive yet heavily criticized 1990 S-night (street and shelter) operation (U.S. Bureau of the Census 1992).

Although most experts now dismiss the advocate-generated 2 million figure as groundless, the remaining estimates vary considerably. One explanation for this variation is that all are point estimates, depicting the size of the homeless population at a specific moment (e.g., a particular day or week). To the extent that the number of homeless changed during the 1980s, studies conducted on different dates should produce different results. Indeed, the trend retrospectively uncovered by several investigators (Jencks 1994)—slow growth early in the decade, rapid increase in the middle, and decline after 1987–1988—seems consistent with the magnitudes of the HUD, Urban Institute, and Census estimates. Others believe that the homeless population grew rapidly throughout the decade, by as much as 25 percent annually in some places. That growth rate could be inflated, though, given the relative stability documented in one of the few large cities (Nashville, Tennessee) for which longitudinal observations are available (Lee 1989).

It is hard to know whether the most credible point estimates accurately reflect the true scope of homelessness. If the homeless population is marked by high turnover, with many people entering and exiting quickly, the total number who experience homelessness over a longer period will be grossly underestimated by a point estimate. Two recent period-prevalence studies illustrate this dynamic. In the first study, counts of unduplicated shelter users in New York and Philadelphia suggest that roughly 1 percent of the residents of both cities are homeless each year, and the figure rises to 3 percent for a three-to-five-year interval (Culhane et al. 1994). In the second, 15 percent of the respondents to a nationally representative telephone survey reported that they had been literally homeless or had doubled up with someone else during their lifetimes (Link et al. 1995).

While definitional and methodological differences underlie much of the disagreement over the magnitude of the homeless population, generalizations about its composition have been complicated by (1) the selective emphasis of many inquiries on atypical "slices" of the whole (homeless veterans, the mentally ill, etc.) and (2) real variation in the characteristics of the homeless across communities. Contrary to media reports and popular perceptions, the modal homeless individual is still an unattached male with local roots, similar in fundamental ways to his skid row counterpart of the 1950s or 1960s. Yet there clearly have been significant compositional shifts during the intervening period. Blacks and other minorities, rarely found on skid row, are now overrepresented among the homeless, and women, children, young adults, and high school graduates constitute larger segments of the population both absolutely and proportionally than they once did (Burt 1992; Rossi 1989). Family groupings, usually headed by the mother alone, have become more common as well. Taking these elements of demographic continuity and change together, perhaps the safest conclusion to be drawn is that a trend toward greater diversity distinguishes the new homelessness from the old.

The same conclusion applies with respect to deviant characteristics. Alcoholism, which previously constituted the most noticeable form of deviance among the homeless, is now rivaled by other kinds of substance abuse, and mental illness has surpassed physical illness as an object of public concern. Beyond a rough consensus regarding the greater variety of such problems in the current homeless population, little of a definitive nature is known about them. For example, a review of nine studies cited mental illness prevalence rates that run from a low of one-tenth to a high of one-half of all homeless (U.S. General Accounting Office 1988), and occasional reports suggest that as many as 90 percent are at least mildly clinically impaired. This wide range leaves room for opposing arguments: on the one hand, that pervasive mental illness is the principal cause of contemporary homelessness; on the other, that its presumed causal role represents a stereotypic myth created by the visibility of a small minority of disturbed folk.

Even if the extent of mental illness has been exaggerated, there can be no doubt that the general well-being of the homeless remains low. This is hardly surprising in light of the stresses that accompany life on the street. The absence of shelter exposes homeless persons to the weather, violence, and other threatening conditions. They have trouble fulfilling basic needs that most Americans take for granted, such as finding a job, obtaining nutritionally adequate meals, getting around town, washing clothes, storing belongings, and locating toilet and bathing facilities. To cope with these difficulties, homeless people draw on a repertoire of subsistence strategies (Snow and Anderson 1993). One of the most common is temporary low-wage employment, often as a day laborer. For some, shadow work—engaging in unconventional activities outside the formal economy (scavenging, panhandling, selling blood, trading junk)—offers a means of survival. Others resort to crime, especially petty theft, prostitution, and drug dealing, or become dependent on service providers.

While frequently creative, such strategies heighten the physical health risks to which the homeless are subjected. Compared to the settled population, a larger percentage of homeless individuals suffer from chronic disorders, and rates for most infectious diseases are at least five to six times greater (Wright et al. 1998). The collective consequence of these conditions is a drastically shortened life expectancy. However, to identify homelessness as the direct cause of higher morbidity and mortality would be an oversimplification. Preexisting health problems can reduce a person's employability, prompting a downward "drift" toward homelessness and lessening the chances of returning to a normal life. Homelessness can also be a complicating factor in the provision of health care. In part because of their circumstances (e.g., lacking transportation, distrusting authorities, being unable to store medicine), many homeless miss appointments and do not follow through with their prescribed treatment. They are, in short, less than ideal patients from the perspective of health professionals, whose goal is to insure continuity of care.

Poor health and other disadvantages associated with homelessness tend to worsen as the length of time on the streets increases. Some people still experience the longer-duration bouts common in the skid row era; close to 10 percent may be homeless for five continuous years or more. These "chronics," by virtue of their visibility, disproportionately influence public perceptions of who the homeless are, but they now constitute the exception rather than the rule. Results from most surveys indicate that the median episode of homelessness lasts between two months and one year (Burt 1992; Link et al. 1995). Of the persons who fall into this "temporary" category, some are homeless only once in their lives. Many, though, exhibit a more complex pattern marked by frequent exits from and returns to homelessness (Piliavin et al. 1996). For such individuals, being without shelter is just one manifestation of prolonged residential instability.

Whether temporarily or chronically homeless, few prefer to be in that state. But if preference can be ruled out, what forces account for the new homelessness? Among the numerous answers elicited by this question so far, two general classes are discernible. Structural explanations treat homelessness as a function of large-scale trends that constrain people's chances for success and that are beyond their immediate control. Scholars point in particular to (1) the decreasing availability of affordable housing; (2) the growth of the poverty population; (3) changes in the economy (e.g., deindustrialization and the expansion of the service sector) resulting in fewer decent-paying, limited-skill jobs; (4) intensifying competition among members of the baby boom cohort during their adult years; (5) the declining appeal of marriage (and the heightened vulnerability of unmarried women and men); (6) the deinstitutionalization movement in mental health care policy; and (7) wider access to controlled substances, dramatically illustrated by the crack cocaine "epidemic" (Burt 1992; Jencks 1994; Wright et al. 1998). The rise of the new homeless is typically attributed to the convergence of two or more of these trends in the 1980s.

The availability of affordable housing has probably received the most attention of any structural factor, in part because all the other trends are thought to operate in conjunction with this one to produce homelessness. The thrust of the housing thesis is that government action, a supply–demand imbalance, inner-city revitalization, and related events have not only priced many low-income households out of rental status but have also eliminated a key fallback option historically open to them: SRO units in downtown residential hotels (Hoch and Slayton 1989; Ringheim 1990). With the depletion of the SRO stock, displacement from other sectors of the housing market may lead directly to a homeless outcome.

In contrast to the structural approach, individualistic explanations posit traits, orientations, or experiences specific to the person as the main causes of homelessness. Few researchers have found much evidence that lacking permanent residence is a freely chosen lifestyle. Nevertheless, the enlargement of the emergency shelter system in recent years has made it easier for poor people who are exposed to domestic conflict or doubled up in a crowded unit to voluntarily head for a shelter as a way of coping with their untenable housing situations. In similar fashion, older thinking about the inherent immorality and wanderlust of skid row denizens has given way to revisionist claims that the primary antecedents of homelessness are deficits in talent or motivation or the debilitating effects of mental illness or substance abuse. Traumatic life events, either in childhood (e.g., sexual violence, placement in foster care or an orphanage) or adulthood (divorce, job loss, a serious health problem), can increase the likelihood of homelessness as well.

Interestingly, many experts who subscribe to some version of the individualistic view have had to invoke associated structural trends—deinstitutionalization in the case of mental illness, for example—in order to explain the size and compositional changes that have occurred in the homeless population in recent years. The tendency to draw on both individualistic and structural perspectives has grown more pronounced with the realization that a theory of homelessness, like that of any social phenomenon, can never be fully satisfying when cast in exclusively micro- or macro-level terms. To date, the work of Rossi (1989) offers the most compelling cross-level synthesis. He contends that structural changes have put everyone in extreme poverty at higher risk of becoming homeless, especially those poor people who exhibit an "accumulation of disabilities," such as drug abuse, bad health, unemployment, and a criminal record. Being "disabled" forces one to rely on a network of friends and family for support, often over prolonged periods. If the strain placed on this support network is too great and it collapses, homelessness is the likely result.

Though Rossi's central idea—that structural factors and individual problems combine to make certain segments of the poor more vulnerable to homelessness than others—seems reasonable to social scientists, it could prove less acceptable to members of the general public. Based on previous research into public beliefs about the causes of poverty, most Americans might be expected to hold the homeless responsible for their lot. However, the small amount of evidence that bears directly on this expectation contradicts rather than confirms it. Findings from a local survey, supplemented with data from a national opinion poll, indicate that (1) more people blame homelessness on structural variables and bad luck than on individualistic causes and (2) many hold a mixture of structural and individualistic beliefs, consistent with the complex roots of the condition (Lee et al. 1990).

The relative frequency of the two types of beliefs is a matter of substantial political significance, since the study just cited shows that each type implies a distinctive set of policy attitudes. As a rule, members of the public who believe in structural causes consider homelessness a very important problem, feel that the response to it has been inadequate, and endorse a variety of corrective proposals, including a tax increase and government-subsidized housing. This policy orientation stands at odds with that for individualistic believers, who tend to devalue homelessness as an issue and favor restrictive measures (vagrancy enforcement, access limitation, etc.) over service provision. Regardless of which orientation ultimately registers the greatest impact on policy making, the sharp contrast between them says much about how homelessness has managed to stay near the top of the U.S. domestic social agenda for the past two decades.

Homelessness also persists as an issue because it is so hard to solve. Out of frustration, many communities have resorted to controlling the homeless. Historically, mechanisms to achieve this goal have included expulsion, spatial containment, and institutionalization (the latter for the sake of monitoring, rehabilitation, or punishment). Other efforts have been aimed at amelioration. For example, the Stewart B. McKinney Homeless Assistance Act recognizes the responsibility of the federal government to meet the basic needs of the "down and out." Since the McKinney Act was signed into law in 1987, it has authorized billions of dollars for food, shelter, health care, and other forms of aid (Foscarinis 1996). However, most of the funding is used to support emergency relief programs. The act designates only modest amounts for reintegration initiatives (for example, moving people into transitional or permanent housing) and virtually nothing for prevention. In short, it treats symptoms but not causes.

The effectiveness of legislation like the McKinney Act is further hindered by our federal system of government, which requires an unrealistically high degree of coordination among units at different levels to insure successful and equitable implementation. The current political climate does not bode well for such legislation, either. Repeated challenges have been made to the McKinney Act; critics want to reduce the size of the federal commitment, redirect the homeless toward existing social services (although many do not appear eligible to receive benefits), and give local government more flexibility. In practice, this is likely to mean a continuation of the piecemeal approach already taken in many places, with an assortment of nonprofit organizations, religious groups, advocates, volunteers, and state and municipal agencies attempting to do their part. As long as communities lack specific intervention strategies for keeping at-risk residents from losing their housing and for equipping them with essential skills, there will be little change in the status quo.

The United Nations' designation of 1987 as the "Year of Shelter for the Homeless" attests that homelessness has been an international as well as an American concern. The situation in Europe resembles that in the United States in several respects. Although rates of homelessness appear to be slightly lower across the dozen or so European countries for which data are available, the number of people affected annually (at least 2.5 million) is large (Wright et al. 1998). The compositional profile of the European homeless population looks familiar: Its members are disproportionately single, male, from disadvantaged socioeconomic backgrounds, and in poor physical and mental health. Like their American counterparts, they have become homeless as a result of both structural pressures (e.g., a poverty and affordable housing "squeeze") and individual experiences (family breakup, substance abuse, etc.). Remedies for these causes are no easier to come by in Europe than they are in the United States. The primary response thus far has been to offer emergency relief, with the burden of service provision falling on the private sector.

Homelessness takes a different, more acute form in the developing countries of the Third World, where rapid population growth outstrips the expansion of the housing stock and the economy by a wide margin. Compounding the growth–housing mismatch are prevailing patterns of spatial redistribution: Rural-to-urban migration streams have created huge pools of homeless people in tenements, in squatter communities, and on the streets of many large cities. Besides such demographic trends, periodic events of the kind that once created literal homelessness in premodern societies—drought, earthquakes, food shortages, and the like—still contribute to the problem today outside the West. War (including "ethnic cleansing") and political instability add to the toll.

What is perhaps most striking about homelessness in the Third World context is its youthful face. Visitors to developing nations cannot help but notice the ubiquitous street children; UNICEF estimates that there may be as many as 100 million globally (Glasser 1994). A majority are "on the street" during the daytime, typically performing some sort of economic activity (begging, vending, etc.), but they have a family and dwelling to return to at night. Perhaps 10 percent qualify as literally homeless or "of the street." The children belonging to this group may have run away from difficult family circumstances, been discarded as "surplus kids" by parents unable or unwilling to care for them, or been discharged from an orphanage or other institutional setting. Because children of the street must hustle to survive, they are occasionally romanticized as savvy and resilient. But they also lack adequate diets, are susceptible to criminal victimization, and engage in behaviors such as drug use and prostitution that jeopardize their health.

Sadly, the prospects for weaving a safety net to catch homeless children and adults—let alone for targeting the sources of the problem—must be judged slim in the face of the financial debts, service demands, and other burdens under which Third World governments operate. Possibly because these burdens are so overwhelming, homelessness—while important—has yet to achieve dominant-issue standing. As one informed observer put the matter, "neither the resources to address the plight of the homeless nor the degree of aroused public sympathy present in the United States are in evidence in the developing world" (Knight 1987, p. 268). However, that is the sector of the world in which a vast majority of all homeless persons will continue to live for the foreseeable future.

——, Sue Hinze Jones, and David W. Lewis 1990 "Public Beliefs About the Causes of Homelessness." Social Forces 69:253–265.

Link, Bruce, Jo Phelan, Michaeline Bresnahan, Ann Stueve, Robert Moore, and Ezra Susser 1995 "Lifetime and Five-Year Prevalence of Homelessness in the United States: New Evidence on an Old Debate." American Journal of Orthopsychiatry 65:347–354.

U.S. Bureau of the Census 1992 Statistical Abstract of theUnited States: 1992 (112th ed.). Washington, D.C.: U.S. Government Printing Office.

U.S. Department of Housing and Urban Development 1984 A Report to the Secretary on the Homeless andEmergency Shelters. Washington, D.C.: Office of Policy Development and Research, U.S. Department of Housing and Urban Development.

U.S. General Accounting Office 1988 Homeless MentallyIll: Problems and Options in Estimating Numbers andTrends. Washington, D.C.: Program Evaluation and Methodology Division, U.S. General Accounting Office.

Wallace, Samuel E. 1965 Skid Row as a Way of Life. Totowa, N.J.: Bedminster.

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Homelessness

Encyclopedia of the Great Depression
COPYRIGHT 2004 The Gale Group Inc.

HOMELESSNESS

Poor people without permanent shelter have always had a presence in the United States, and the homeless were much noticed on the edges of growing cities or riding the railroads during the nineteenth century. But Hooverville shantytowns and migrant Okie families driving West during the Depression brought unprecedented national attention and federal intervention to the problem of homelessness. Even during the Depression years, however, the experience of the homeless was not uniform and aid programs were far from comprehensive. Public response to the homeless alternated between antagonism and empathy.

In the late 1920s there were already increasing numbers of homeless people in community shelters. When the Depression hit, many of the newly unemployed headed to cities looking for jobs, overwhelming municipal lodging houses and private agencies. In 1931, for example, the number of homeless using shelters in Minneapolis increased fourfold over the previous year. Local and regional response was mixed, but certain patterns emerged. Cities could be more or less lenient in enforcing settlement laws, which mandated prior residency for relief and the return of potential public charges to their state of legal residence. In practice, though, few cities offered more than a night's shelter and a meal for nonresidents. In the Deep South, transients could be arrested and sent to work on chain gangs, and the few cities that had municipal shelters for the local poor excluded African Americans from them. Chicago expanded separate services for
the homeless of both races, and a 1931 protest of the homeless in New York City led to improvements at the municipal lodging house. Still, much of the additional shelter was provided by private organizations like the Salvation Army. Religious missions provided shelter regardless of residency status, though they required that the homeless attend religious services. Small charities started soup kitchens and breadlines for anyone who was hungry.

Contemporary depictions of the homeless portrayed those waiting in breadlines as iconic victims of the nation's economic ruin. Though single women were frequently absent from the lines and rarely represented, they made up an increasing, though still small, percentage of the conservatively estimated 1.25 million unattached (i.e., not in families) homeless tallied in a 1933 census of 765 cities. The standard social work policy was to send transient women back to the residence of their families or husbands, so some homeless women avoided urban aid agencies. Many traveled on trains dressed in men's clothes, though this did not insure their safety. As "Boxcar" Bertha Thompson recalled, female hobos, like their male counterparts, took to the road for lack of money and the desire for freedom.

More visible was the increasing number of beggars. It became untenable to enforce anti-begging laws when some poor people deliberately tried to
get arrested for the shelter of a lockup and when the increasing number of newly unemployed semi-skilled and white-collar workers elicited public sympathy. Most visible, perhaps, were the homeless who rode in boxcars and set up hobo camps or "jungles" at junctions and in cities. In 1932, World War I veterans traveled by train to Washington, D.C., and set up a large shantytown that swelled with those who supported their demand for advance payment of war bonuses. When President Herbert Hoover sent the U.S. Army to route this "bonus army" of the country's "worthiest" poor, public opinion turned even more against him.

The increasing number of homeless children—an estimated one-fifth of the homeless population was nineteen or younger—also attracted the attention of advocates. Many of these youngsters left home so as not to burden their families, which often were already disrupted or on relief. In 1932 a coalition of welfare advocates urged the Senate to pass a federal homeless program that would, in providing relief for the transient homeless, save the character of America's children.

In May 1933, President Roosevelt established the Federal Transient Service (FTS) as part of the Federal Emergency Relief Act. FTS was designed to provide aid for homeless people who were ineligible for local relief because they had not lived in any given state for more than the year required for settlement status. FTS eventually established programs in every state except Vermont. The service allotted the most money to California, which, with 4.7 percent of the nation's population, handled 14 percent of the nation's transients. FTS ran shelters that provided food, clothing, and medical care to residents, as well as work training and education programs to some who stayed for long periods. FTS also started camps in rural areas where homeless men were assigned public work and conservation projects, such as flood control and park improvement. Many camps and centers were partly self-governed and staffed by residents. FTS also paid for rooms in boarding houses or YMCAs to accommodate transient women, and the agency allotted apartments and relief payments to families; as Harry Hopkins, director of the Federal Emergency Relief Administration, wrote, "shelter care for families
was taboo." FTS left the issue of integration and equality up to local practice. Many urban FTS centers were segregated, and in the South separate black shelters were, according to a 1934 FTS report, "not quite equal to those provided for the whites."

In 1935, FTS was phased out because, according to Hopkins, transients had "to be recognized as being no different from the rest of the unemployed." The end of FTS marked a general shift away from direct relief and toward work-related and constituency-specific New Deal programs. However, only about 20 percent of the unemployed transients formerly housed by FTS were able to get jobs with the Works Progress Administration; few young transients were eligible for the Civilian Conservation
Corps, and the Resettlement Administration's forty-five camps for migratory workers could not meet demand. Meanwhile, the number of homeless people increased in the latter half of the decade as factories closed and tenant farmers were displaced. Moreover, between January 1938 and October 1939, eight states increased residency requirements for relief. Few states allowed settlement status to carry over until acquired in another state so that typically those who moved were ineligible for aid. In most cities, overwhelmed private shelters and police stations led to increased hostility towards transients. Some communities, especially in the South and West, used extralegal means, such as border patrols, forced removals, and unwarranted arrests, to keep the homeless out.

John Steinbeck's portrayal of a transient farm family's struggle for survival in The Grapes of Wrath(1939) raised public sympathy for the homeless, though it did not address the majority of the homeless population, which lived in cities, and the dis-proportionate number of homeless African Americans and Mexican seasonal workers. A month after the premier of John Ford's 1940 film version of Steinbeck's story, a House committee began hearings on interstate migration of the destitute, but the advent of World War II shifted its focus to an investigation of defense migration. As many of the homeless joined the army and found employment in war industries, relief programs were reduced and city shelters closed; those homeless who remained were left to the missions, casual employment agencies, and skid row hotels. It was not until 1969 that the Supreme Court declared unconstitutional the residency requirements for benefit eligibility. Homelessness would not recapture the national attention it had during the Depression until the late
1970s, when it was thrust to the fore as a result of deindustrialization and urban renewal.

Citation styles

Encyclopedia.com gives you the ability to cite reference entries and articles according to common styles from the Modern Language Association (MLA), The Chicago Manual of Style, and the American Psychological Association (APA).

Within the “Cite this article” tool, pick a style to see how all available information looks when formatted according to that style. Then, copy and paste the text into your bibliography or works cited list.

Because each style has its own formatting nuances that evolve over time and not all information is available for every reference entry or article, Encyclopedia.com cannot guarantee each citation it generates. Therefore, it’s best to use Encyclopedia.com citations as a starting point before checking the style against your school or publication’s requirements and the most-recent information available at these sites:

Modern Language Association

The Chicago Manual of Style

American Psychological Association

Notes:

Most online reference entries and articles do not have page numbers. Therefore, that information is unavailable for most Encyclopedia.com content. However, the date of retrieval is often important. Refer to each style’s convention regarding the best way to format page numbers and retrieval dates.

In addition to the MLA, Chicago, and APA styles, your school, university, publication, or institution may have its own requirements for citations. Therefore, be sure to refer to those guidelines when editing your bibliography or works cited list.